<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622314
Report Date: 09/23/2022
Date Signed: 09/23/2022 01:40:13 PM

Document Has Been Signed on 09/23/2022 01:40 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:EAGAN, KACYFACILITY NUMBER:
313622314
ADMINISTRATOR:EAGAN, KACYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 401-6212
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
09/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Kacy EaganTIME COMPLETED:
02:20 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
On September 23, 2022 Licensing Program Analysts (LPAs) Lea Habtom and Katrina Owens met with licensee Kacy Eagan. The purpose of today's inspection is to clear the deficiencies cited on August 8, 2022. The census for today consisted of 5 children with 1 infant and 4 preschool children being supervised by licensee and her assistant. LPAs confirmed that licensee has removed the unfingerprinted adult from the home and have cleared the deficiency.

No Title 22 regulations were cited during today's inspection.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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