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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500803
Report Date: 02/15/2023
Date Signed: 02/16/2024 12:15:49 PM

Document Has Been Signed on 02/16/2024 12:15 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:CHEW,ANNA KRISTINEFACILITY NUMBER:
394500803
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/15/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Anna Kristine ChewTIME COMPLETED:
11:45 AM
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This is an amended version of a report originally signed on 02/15/23.
On Wednesday, February 15, 2023, Licensing Program Analyst (LPA) Elvira Sierra met with Applicant, Anna Kristine Chew for the purpose of a change of location. Previous license #394500426. Home is a single story 3 bedrooms 2 bathrooms house. Facility hours of operation will be M-F from 07:00 am to 06:00 pm. All individuals subject to criminal background review have obtained a criminal record clearance.

A health and safety inspection was conducted in all areas accessible to children. Home appears orderly and suitable for children. Off-limits areas include; Bedroom # 2 and # 3, Bathroom #2, Garage, Front yard and a portion of the right side of the backyard (garbage area location). Parent's Rights, current Emergency Disaster plan and COVID-19 posting was observed to be posted. Hazardous items were stored inaccessible to children. Napping equipment and age appropriate toys were observed. Applicant stated there are no weapons in the home and no bodies of water were observed. Home as a working telephone, 2A10BC fire extinguisher and a functioning smoke and carbon monoxide detectors. The backyard is fenced for supervision. Facility will provide meals. Applicant demonstrated control of property of the above address.

Applicant understands that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed changes. Applicant current CPR/First Aid was verified (01//24).

Effective today (02/15/23) the facility is LICENSED to serve a MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. CAP 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

Exit interview conducted, this report and Appeal of Rights were reviewed and provided to Applicant, Anna Kristine Chew.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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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