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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409405
Report Date: 07/26/2023
Date Signed: 07/26/2023 04:47:23 PM

Document Has Been Signed on 07/26/2023 04:47 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SHIRDEL, SARAFACILITY NUMBER:
073409405
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
07/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:SARA SHIRDELTIME COMPLETED:
05:00 PM
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Licensing Program Analyst Tasha Alexander met today with licensee Sara Shirdel to conduct an Increase of capacity inspection. Present for today's inspection is licensee, her 12 year old daughter and 5 children in care consisting of 3 infants and 2 toddlers. Lpa conducted a relocation inspection at this facility in May 2023 so a full comprehensive inspection will not be conducted today. There is a fully charged 2A10BC fire extinguisher, working smoke alarm and working carbon monoxide detector in the home. The off-limits areas are the living room, master bathroom, the area on the right side of the backyard which houses the barbeque, and the detached garage in the front of the home.

Per fire department- the detached garage is off limits to children in care.

There are no deficiencies cited today. The home will be licensed for a large capacity license as of today 7/26/23. Congratulations!

An exit interview was conducted
A notice of site visit was posted.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2023
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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