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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343626889
Report Date: 06/06/2025
Date Signed: 06/30/2025 09:34:57 AM

Document Has Been Signed on 06/30/2025 09:34 AM - 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:SINGLE MOM STRONGFACILITY NUMBER:
343626889
ADMINISTRATOR/
DIRECTOR:		ELICIA ADA-FABELAFACILITY TYPE:
860
ADDRESS:500 ARDEN WAYTELEPHONE:
(916) 687-1282
CITY:SACRAMENTOSTATE: CAZIP CODE:
95815
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 0DATE:
06/06/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Tara TaylorTIME VISIT/
INSPECTION COMPLETED:
11:45 PM
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On June 6, 2025, at approximately 9:30 AM Licensing Program Analysts (LPAs) Pa Dao Vang and Josiah Gathing met with Applicant Tara Taylor for the purpose of an announced change of component pre-licensing inspection. Applicant requests a school age license to serve 30 children from ages 5 to 13 years. The program will operate Monday through Friday from 7:30 AM to 5:45 PM.

Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, Effects of Lead Exposure brochure, menus, and daily schedule. LPM discussed the forms that must be in each child's file and each staff member's file. The facility will provide AM snack and PM snacks. Parents will provide children’s lunch from home. The facility will also provide filter drinking water for children daily. LPA Vang received the STD.850 Fire Safety Inspection Request with fire clearance on May 29, 2025.

INDOOR ACTIVITY SPACE:
There is one large room in the building. LPAs observed a sufficient amount of equipment, toys, chairs and tables. There are sufficient cots and nap mats available for children throughout the day. There are first aid kit supplies, a fully charged fire extinguisher, and trash cans with lids. Applicant stated medications will be stored in the office. Applicant stated there are no poisons or firearms on the premises. There is a functional carbon monoxide detector in the facility. LPA observed daily sign-in and sign-out on a clip board.

The classroom space contains a total of 1735.54 square feet, which accommodates Applicant's request for 30 school age children. There are 2 sinks and 2 toilets available for children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).
Report continues on LIC809-C…
NAME OF LICENSING PROGRAM MANAGER: Seychelle De Luca
NAME OF LICENSING PROGRAM ANALYST: Dao Vang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SINGLE MOM STRONG
FACILITY NUMBER: 343626889
VISIT DATE: 06/06/2025
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OUTDOOR ACTIVITY SPACE:
There outdoor play yard is gated with a fence over four feet. LPAs observed a sufficient amount of equipment and toys provided to children for outdoor activities. There are no bodies of water on the premises. There are shaded areas supplied by structures and trees.

LPAs measured the outdoor space, in which contains a total of 1501.92 square feet, which accommodates 20 children at a time. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Applicant also emailed LPA Vang an outdoor waiver request to accommodate 20 children at a time.

The facility's Plan of Operation is located in the facility file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.

The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPAs discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; criminal record clearances, inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Director any changes that may occur regarding the directors or an employee acting in the director's absence must be reported to department within 10 working days.

Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

As of June 6, 2025, the facility is approved to operate with a total capacity of 30 school age children ages 5 to 13 years. This facility evaluation report was reviewed and discussed with Applicant Tara Taylor. LPAs also reviewed and provided a copy of the outdoor waiver for Applicant to post with the postings.

NAME OF LICENSING PROGRAM MANAGER: Seychelle De Luca
NAME OF LICENSING PROGRAM ANALYST: Dao Vang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
LIC809 (FAS) - (06/04)
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