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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617929
Report Date: 06/28/2023
Date Signed: 06/28/2023 12:07:22 PM

Document Has Been Signed on 06/28/2023 12:07 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:HOLUB, JANETFACILITY NUMBER:
343617929
ADMINISTRATOR:HOLUB, JANETFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 439-0585
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
06/28/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Janet HolubTIME COMPLETED:
12:20 PM
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At 11:30 a.m. on Wednesday, June 28th, 2023, Licensing Program Analyst (LPA) Karyn Guerra, met with Licensee, Janet Holub, for the purpose of a unannounced Case Management- Licensee Initiated inspection. LPA observed a census of 7 children including 6 preschoolers and 1 infant. 2 assistants were also present. Licensee requests a room addition of previously off limits converted garage that is now a play space off of the front living space. A fire clearance has been granted, is on file with the department, and no longer restricts use of the space. During today's inspection, LPA inspected the room addition and did not observe any hazards. Effective today, June 28th, 2023, the room addition is approved.

LPA also informed Licensee of regional office relocation and provided updated parent's rights form and poster.

No deficiencies were cited during inspection. This report was reviewed with the Licensee, and an exit interview conducted. A notice of site visit was provided and shall remain posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2023
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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