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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624315
Report Date: 08/01/2023
Date Signed: 08/01/2023 04:45:01 PM

Document Has Been Signed on 08/01/2023 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HARRIS, MONIQUEFACILITY NUMBER:
343624315
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
08/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Tuesday RobinsonTIME COMPLETED:
11:10 AM
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Licensing Program Analysts (LPAs) Gagandeep Singh and Dao Vang met with the helper, Tuesday Robinson, for a case management inspection. Another helper arrived at the facility during the inspection. Both of the helpers had criminal background clearance of file. The applicant submitted an application for capacity increase from eight to fourteen children in care. Local fire department has conducted the inspection and granted the clearance. Purpose of today's inspection was to inspect the facility and inform the licensee about the regulations and requirements for large license.

During today's inspection, LPAs inspected the day care area. Day care areas are Living room, Dining area, Kitchen, Bathroom and Backyard. Off limit areas: entire second floor, garage and storage shed in backyard. Present, there are five children in care, including licensee's own three children. LPAs observed licensee has license and other required documents posted next to the entrance. LPAs observed the there is working carbon monoxide detector, smoke alarm and fully charged fire extinguisher in the house. Stairs were barricaded with child protective gate. There is no pools, spas or other bodies of water on site. There are first aid supplies available in the house. LPAs did not observe any chemical or hazard items in the kitchen cabinets. During inspection, LPAs discussed the regulations of large license capacity and ratios with the helper and a handout was provided.

Exit interview was conducted. Copy of this report was reviewed and provided to the helper, Tuesday Robinson. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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