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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500334
Report Date: 07/19/2023
Date Signed: 07/19/2023 09:33:13 AM

Document Has Been Signed on 07/19/2023 09:33 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CHORDAS, MELISSAFACILITY NUMBER:
574500334
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
07/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Melissa ChordasTIME COMPLETED:
09:45 AM
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On 7/19/2023, Licensing Program Analysts (LPAs) Jennie Tedlos and Lauren Scott conducted a Case Management Inspection for the purpose of an increase in capacity. LPA met with Licensee Melissa Chordas. LPA observed 5 children supervised by Licensee.

LPA and Licensee toured the home and inspected all on-limits areas. At time of inspection, Licensee requested to make Bedroom #1 from off limits to on limits. Licensee also requested to make the living room off-limits. LPA was shown Bedroom #1. Current off limit areas of the facility will now be: Master Bedroom, Kitchen, Laundry, Garage, Living Room & East Side of Backyard.

Licensee was granted a fire clearance by Davis Fire Department on 7/3/2023. Effective today's date, 07/19/2023, LPAs will approve the capacity increase to serve up to either 14 children, one (1) of which must be enrolled in Kindergarten and at least one (1) 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2.

In the areas that were evaluated today, no deficiencies were observed. An exit interview was conducted and Notice of Site Visit was posted by LPA and must remain posted for 30 days. A failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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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