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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009179
Report Date: 07/13/2021
Date Signed: 07/13/2021 03:02:57 PM

Document Has Been Signed on 07/13/2021 03:02 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:MELDERS, PAMELA FCCHFACILITY NUMBER:
483009179
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
07/13/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Pamela MeldersTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with Pam Melders for a capacity increase case management visit.

The facility has functioning smoke and carbon monoxide detectors. The fire extinguisher is rated at 2A10BC is mounted in the hallway between the kitchen and front living room. The pull station is also mounted in this location. The Fairfield Fire Inspector conducted the fire safety inspection on 7/12/2021 and an approved report was received by the department on July 13, 2021. A copy of the fire inspection report was given to the licensee.

The license is aware of the child capacity requirement for a large family child care home provider.

The licensee is approved as a large family child care home effective July 13, 2021.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2021
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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