Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293605639
Report Date: 09/11/2018
Date Signed: 09/11/2018 01:32:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:DOTHEE, TULUMFACILITY NUMBER:
293605639
ADMINISTRATOR:DOTHEE, TULUMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 271-1258
CITY:ROUGH & READYSTATE: CAZIP CODE:
95975
CAPACITY:14CENSUS: 9DATE:
09/11/2018
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Tulum DotheeTIME COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Keven Peters made an unannounced inspection to the facility for the purpose of conducting a Case Management Incident visit. This is in regards to an Unusual Incident Report that was submitted on 09/04/2018 via mail. Licensee reported police activity on and near her property. The individual who cuts the lawn was taken into custody by CHP after a report was made by a passing vehicle that he was yelling at the cars to slow down as they drove by.

The children did not hear or witness the activity. Parents were briefly delayed in being able pick up children due to CHP closing the road in both directions.

LPA interviewed staff, LPA toured the area where the Unusual Incident occurred. Today’s census upon arrival was 9 preschool age children with 2 staff. The licensee states that she has instructed the individual that he is to cut the lawn on weekends or after child care hours.

After discussion with staff and observing the area, LPA determined that no Title 22 violations took place.

Report was reviewed with the director, exit interview was conducted.

Notice of site visit posted.

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1