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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700332
Report Date: 12/07/2020
Date Signed: 12/08/2020 08:21:25 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:A PLACE CALLED HOME IIFACILITY NUMBER:
392700332
ADMINISTRATOR:SIMONE A PIERRE JEROMEFACILITY TYPE:
740
ADDRESS:25820 MAGNOLIA AVETELEPHONE:
(209) 986-3949
CITY:ESCALONSTATE: CAZIP CODE:
95320
CAPACITY:11CENSUS: 11DATE:
12/07/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
04:33 PM
MET WITH:Lesley PinolaTIME COMPLETED:
05:30 PM
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LPA Johnson met with Licensee Lesley Pinola via telephone to conduct a case management call due to COVID-19 and pre-cautionary measures. This is to clear POCs from complaint/audit findings on 11/06/2020. Title 22 regulations: 87405 (d)(1-7), 87218(a)(1)(2) and HSC 1569.652 are still outstanding and not cleared.

Civil penalties of $100.00 per day, per violation, have been accruing since 11/17/20 for the 87218(a)(1)(2) and HSC 1569.652 citations. The citation
87405(d)(1-7) has been accruing since 11/10/2020.

Civil penalties shall be assessed during today's call.

Licensee is notified that the civil penalties for Title 22 regulations: 87405 (d)(1-7), 87218(a)(1)(2) and HSC 1569.652 continue to run and accrue at $100.00 per day, per violation until corrections are made. Licensee is reminded to contact LPA when she has talked with her attorney and these corrections or request for an extension have been made.

Exit interview was conducted with Licensee where LPA reviewed report. An electronic copy of the report was emailed to the facility to obtain a signature from the Licensee and emailed back to LPA to be filed.



SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) -26-4752
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020
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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