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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313624246
Report Date: 09/20/2022
Date Signed: 09/20/2022 01:05:12 PM

Document Has Been Signed on 09/20/2022 01:05 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:FLAKE, KRISTYFACILITY NUMBER:
313624246
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
09/20/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kristie FlakeTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPAs) Amanda Blesi and Lea Habtom met with Licensee Kristie Flake to conduct a Change of Capacity inspection. The Licensee is requesting an increase from eight to 14 children. Today's census was six children in care with the Licensee and licensee's spouse.

Off-limit areas consist of upstairs bedrooms, detached garage, locked well house, second fenced area in the backyard (pasture area). Applicant understands that children may never enter the off-limit areas. LPA observed a fire extinguisher and functioning smoke alarm and carbon monoxide detector. LPA observed that hazardous items and chemicals were stored inaccessible to children in care. LPA observed the home was clean, safe, sanitary, and in good repair with appropriate toys for the children. In the areas that were evaluated during today's inspection, the facility is in compliance.

A Fire Safety Inspection Clearance (STD850) was received on 9/14/22 from South Placer Fire Department and the home has been cleared for up to 14 children.

Applicant is now approved to operate as a Large Family Child Care Home as of today, September 20th, 2022. Facility is now licensed to serve a maximum capacity (when there is an assistant present) of 12 children with no more than four infants OR a capacity of 14 children no more than three Infants; one child must be in Transitional Kindergarten/Elementary School and one child must be at least six years old. If there is not an assistant present, the facility must revert to a Small Family Child Care Home license.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee Kristie Flake

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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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