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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625063
Report Date: 04/23/2024
Date Signed: 04/23/2024 07:32:46 PM

Document Has Been Signed on 04/23/2024 07:32 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:SMITH, ANNALISAFACILITY NUMBER:
343625063
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
04/23/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Annalisa SmithTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with the licensee, Annalisa Smith, for an inspection. The licensee applied for an increase of capacity from eight to fourteen children in care. Purpose of the inspection today was to inspect the facility, provide the information regarding the capacity and ratio regulations of large license.

During today’s inspection, LPA inspected the home. LPA observed the house has proper temperature and ventilation. The house has carbon monoxide detector, smoke alarm, fully charged fire extinguisher and working telephone. There are no pools, spas or other bodies of water on the property. Per licensee, there are no firearm or weapon in the house. LPA discussed the capacity and ratio regulations with the licensee and provided handout. As licensee owns the property, no landlord consent is required. Licensee has record of valid CPR training until October 2024 and Mandated reporter training valid until October 2024. The local fire department has conducted the inspection of the house on April 22, 204 and provided the clearance to the Department.

During today’s inspection, LPA did not observe any hazard in the house. The house has the approved fire inspection. As of today, the licensee will be granted the Large license to provide care for upto fourteen children in care. Copy of this report was reviewed and provided to the licensee. 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: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
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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