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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500840
Report Date: 05/10/2023
Date Signed: 05/10/2023 10:36:15 AM

Document Has Been Signed on 05/10/2023 10:36 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:TATUM-HENDERSON, LATISHAFACILITY NUMBER:
394500840
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/10/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Applicant Latisha Tatum-HendersonTIME COMPLETED:
10:45 AM
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On May 10, 2023, Licensing Program Analyst (LPA) Carla Polanco conducted a follow up pre-licensing visit and met with applicant, Latisha Tatum-Handerson.

The purpose of the inspection was to verify the corrections requested on inspection visit dated 5/2/23. LPA observed the in-ground fishpond in the backyard to be fully emptied of any water and filled with dirt. In addition, LPA observed a fire extinguisher that meets tittle 22 regulations.

Effective today May 10, 2023, 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 and report was reviewed with the Applicant, Latisha Tatum-Henderson.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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