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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500684
Report Date: 11/02/2023
Date Signed: 11/02/2023 01:54:40 PM

Document Has Been Signed on 11/02/2023 01:54 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MADDOX, HOWARD & KARLAFACILITY NUMBER:
394500684
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/02/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Karla MaddoxTIME COMPLETED:
02:20 PM
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On 11/02/23, Licensing Program Analyst(LPA), Elvira Sierra met today with Licensee, Karla Maddox for a Plan Of Correction (POC) inspection. Present in the facility was Licensee and three staff caring for five children.

In addition, LPA checked the day care areas, and the off limit areas. No other children were observed on the premises. Facility is within capacity limits during visit. The facility is in compliance today.

Exit interview conducted, this report and Appeal of Right were reviewed and provided to Licensee. Karla Maddox. Notice of Site Visit posted and should remain posted for 30 days.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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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