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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216000
Report Date: 09/15/2021
Date Signed: 09/15/2021 11:36:33 AM

Document Has Been Signed on 09/15/2021 11:36 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:RUSSELL FCC AKA PITTER PATTER FCCFACILITY NUMBER:
406216000
ADMINISTRATOR:BRITTANY RUSSELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 235-1567
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
09/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:Brittany RussellTIME COMPLETED:
11:40 AM
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On 9/15/21 at 11:17am, Licensing Program Analyst (LPA) Melissa Stewart conducted an unannounced case management inspection and met with Licensee who was supervising nine (9) children including one infant. Also present was one Assistant. LPA conducted a Risk Assessment for COVID19 and all answers indicated no exposure to COVID19 within the past 14 days. LPA explained that the purpose of the visit was provide Licensee with a copy of the Case Management report dated 8/20/21 which was Amended on 9/15/2021 to remove a Type A citation which was issued in error.

A copy of this report and appeal rights were discussed and left with Licensee, Brittany Russell, whose signature on this form confirm receipt of these documents.

LPA observed Licensee post the Notice of Site visit which must remain posted for 30 days.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Melissa K Stewart
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
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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