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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455408094
Report Date: 06/05/2023
Date Signed: 06/05/2023 03:29:07 PM

Document Has Been Signed on 06/05/2023 03:29 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:LACK, KIMBERLY FAMILY CHILD CARE HOMEFACILITY NUMBER:
455408094
ADMINISTRATOR:LACK, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 510-1928
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Kimberly LackTIME COMPLETED:
03:38 PM
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On 06/05/2023 at 3:15pm Licensing Program Analyst, (LPA) Mendez and LPA Sims conducted a case management inspection and met with licensee, Kimberly Lack for the purpose of rescinding the Temporary Suspension Order (TSO) previously issued on 5/19/23 and to observe the updated changes to the layout of the day care room.

On 5/17/23 the licensee’s Fire Clearance was denied due to recent unpermitted construction. Since the TSO was issued, the licensee removed all unpermitted construction and received a new Fire Clearance as of 5/30/23. A copy of this clearance has been received by the Department therefore rescinding the TSO as of 6/2/23.

During today’s inspection the day care room was inspected, and no hazards were observed. A copy of an updated facility sketch was requested (LIC999A). This report was reviewed with the licensee.

Notice of site visit must be posted for 30 days from today's inspection.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2023
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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