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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393604720
Report Date: 12/18/2023
Date Signed: 12/18/2023 10:49:49 AM

Document Has Been Signed on 12/18/2023 10:49 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:VAN DER BEEUREN, RITAFACILITY NUMBER:
393604720
ADMINISTRATOR:VAN DER BEEUREN, RITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 836-2440
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 7DATE:
12/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Rita Van Der BeeurenTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Corina Beckby met with the Licensee, Rita Van Der Beeuren for the purpose of a case management visit to inspect the pool area ensuring no access points are accessible to children. LPA observed Licensee and assistant caring for 7 children including 1 infant.

Licensee stated she sent emails to LPA Beckby and showed LPA Beckby the emails (dates 11/06/2023 & 11/09/2023) she sent LPA with the updated pictures of the pool area. However, LPA Beckby did not receive the pictures, thus the reason for the case management visit. Licensee stated she did not receive any emails from LPA Beckby and stated she does not check the home number. LPA asked and received a better number to communicate with Licensee.

LPA inspected the areas that had potential access to the pool. Licensee has removed the bench by the fence and has added mesh around the left back area of the pool fence denying accessibility of children climbing over the pool gate. LPA provided the new pool waiver to Licensee.

An Exit interview was conducted, and the report was reviewed and provided to Licensee. LPA discussed and provided Appeal Rights to Licensee. LPA posted the Notice of Site Visit and Licensee acknowledges it must remain posted for 30 days. A Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2023
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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