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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408763
Report Date: 02/17/2022
Date Signed: 02/17/2022 11:40:15 AM

Document Has Been Signed on 02/17/2022 11:40 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LIGON, JANELLEFACILITY NUMBER:
073408763
ADMINISTRATOR:LIGON, JANELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 325-2766
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
02/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Janelle LigonTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management inspection. Present during the inspection was the licensee, her foster child and one preschool aged child in care. Currently residing in the home is the licensee, her boyfriend Kevin Davis, her three minor children and two foster children. License also holds a foster care license.
LPA toured the home to conduct a health and safety inspection. Items that pose a danger to children were stored and made inaccessible to children today. The stairs were gated. There are no firearms in the home as stated by the licensee. The home has a pool that is properly fenced with a gate that opens away from the pool and is self latching.

Licensee stated that Kevin Davis moved into her home December 2021. Mr. Davis was fingerprinted 12/29/21. Mr. Davis has not received fingerprint clearance. Licensee stated that Mr. Davis has received an exception for the foster care licensee.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Civil Penalty of $100.00 was assessed today.

Notice of Site Visit was provided and must be posted for 30 days.
Exit interview was conducted and report was reviewed with Janelle Ligon.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
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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Document Has Been Signed on 02/17/2022 11:40 AM - It Cannot Be Edited


Created By: Cherie Acosta On 02/17/2022 at 11:05 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LIGON, JANELLE
FACILITY NUMBER: 073408763

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/18/2022
Section Cited
CCR
102370(d)(1)

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Criminal Record Clearance All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department
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Licensee understands that Kevin Davis must not reside in the home until he receives fingerprint clearance. Licensee shall submit a letter to CCL by 2/18/22 ensuring that Mr. David is no longer residing in the home.
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This requirement was not met as evidenced by: Kevin Davis is residing in the home and has not received fingerprint clearance which poses an immediate risk to the health and safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2022


LIC809 (FAS) - (06/04)
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