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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500541
Report Date: 04/17/2024
Date Signed: 04/17/2024 12:45:48 PM

Document Has Been Signed on 04/17/2024 12:45 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:TAPIA, NORMAFACILITY NUMBER:
574500541
ADMINISTRATOR/
DIRECTOR:		TAPIA, NORMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 402-1815
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
04/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:licensee, Norma TapiaTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On April 17, 2024, Licensing Program Analyst (LPA) Lauren Scott and Office Technician (OT) met with licensee, Norma Tapia, for the purpose of an unannounced case management visit to inspect the pool. LPA toured the facility at time of inspection.

LPA observed and verified the in-ground pool fencing and gate meets Title 22 regulations. LPA verified pool gate swings away from the pool and self latches. All windows and doors that lead to the pool are fenced as well. Backyard is now on-limits for children in care.

Exit interview conducted and report was reviewed with the licensee, Norma Tapia. A Notice of Site Visit was given and must remain posted for 30 days for parental review. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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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