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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093623154
Report Date: 03/22/2024
Date Signed: 03/22/2024 01:18:18 PM

Document Has Been Signed on 03/22/2024 01:18 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EWING, SALLY & DONALDFACILITY NUMBER:
093623154
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
03/22/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Sally and Donald EwingTIME COMPLETED:
01:35 PM
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On March 22nd, 2024, Licensing Program Analyst (LPA) Soleil Marx met with Licensees, Sally and Donald Ewing, for an unannounced licensee initiated case management inspection. The purpose of today's inspection is for a capacity increase from a small license to a large license.

During the inspection there was a census of six children in care being supervised by the licensees. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Saturday 07:00 AM to 05:30 PM.

The off-limit areas include: all bedrooms, closet by hallway, laundry room, garage and front yard. Licensees understand that children may never enter off-limit areas.

A health and safety inspection was conducted in the areas accessible to children. LPA observed the home was safe for children in care and free of hazards. LPA observed gas heater is barricaded to meet regulation. Licensee stated there are no firearms or bodies of water on the premises.

CPR for licensees was verified and expires 11/2025. Mandated Reporter Training was verified for licensees and expires 01/2026.

Pending Fire Clearance approval, THIS FACILITY WILL BE LICENSED FOR A MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6

Licensee understands that when there is no assistant present, the facility reverts back to the ratios of a small capacity.

Exit interview conducted and report was reviewed with the Licensees, Sally and Donald Ewing. Notice of site provided and must remain posted for 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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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