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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621392
Report Date: 06/20/2022
Date Signed: 06/20/2022 02:55:24 PM

Document Has Been Signed on 06/20/2022 02:55 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:MOODY, DOLORISFACILITY NUMBER:
393621392
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
06/20/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Doloris MoodyTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Christopher Jackson and Lauren Scott met with licensee Doloris Moody for the purpose of a Capacity Increase from 8 to 14 children. LPAs toured all areas of the home single story home that are accessible to children, today’s census included two children in care. All adult residents in the home have finger print clearance and are associated to the facility.

Off-limit areas include: All bedrooms. Licensee acknowledged that children may never enter these off-limit areas. LPAs observed a current fire drill log. The Fire Safety Inspection Clearance has been received from the Stockton Fire department, on 05/18/22 and the home has been cleared for up to 14 children. The licensee is utilizing the converted garage as play space for children in care. The space has been approved by the Stockton fire department.

LPAs observed cleaning supplies properly stored out of reach of children. LPAs observed medications out of reach of children. Licensee stated there are no weapons in the home. Fire extinguisher (2A10BC), smoke detector, and carbon monoxide were observed and meet regulation. The backyard is fully fenced. LPAs discussed supervision during today's inspection. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes.

Large family child care home capacity limitations were reviewed during today's visit. Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity

Report continues on 809-C
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: MOODY, DOLORIS
FACILITY NUMBER: 393621392
VISIT DATE: 06/20/2022
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LPAs observed a current CPR/First Aid certificate expires on 08/30/2023. LPAs reviewed a child file and observed they contained emergency contact information and signed Notifications of Parents’ Rights. LPA discussed safe sleep regulations and LPAs advised licensee of their responsibility to stay current in regards to new regulations. LPAs advised licensee to visit the licensing website at http://www.ccld.ca.gov for current forms, laws, regulations and legislation.

Effective today, 06/20/22, LPA is granting a license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in transitional kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old.

Exit interview conducted and report was reviewed with the licensee. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022
LIC809 (FAS) - (06/04)
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