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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093624569
Report Date: 01/09/2024
Date Signed: 01/09/2024 09:47:35 AM

Document Has Been Signed on 01/09/2024 09:47 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NICHELMANN, HALEYFACILITY NUMBER:
093624569
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
01/09/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Haley NichelmannTIME COMPLETED:
10:00 AM
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On January 9th, 2024, Licensing Program Analyst (LPA) Soleil Marx met with Licensee, Haley Nichelmann, for an unannounced licensee initiated case management inspection. The purpose of today's inspection is for a capacity increase from a small licensee to a large license. Fire clearance was granted on 01/03/2024 by El Dorado County Fire Department.

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

A health and safety inspection was conducted in the areas accessible to children. The off-limits areas include: backyard other than fenced in play area, laundry room, hallway bathroom, closets. Licensee understands that children may never enter off-limit areas.

LPA observed firearms within the home are stored and locked to meet regulation. LPA observed hot tub on the premises has been drained, has a hard top cover, and is locked on all 4 sides.

Effective today, 01/09/2024, THIS FACILITY IS 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 applicant, Haley Nichelmann. Notice of site provided and must remain posted for 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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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