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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622567
Report Date: 05/21/2021
Date Signed: 05/21/2021 10:16:11 AM

Document Has Been Signed on 05/21/2021 10:16 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:PETTY, KARENFACILITY NUMBER:
343622567
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/21/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karen PettyTIME COMPLETED:
09:45 AM
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On May 21st, 2021 at 9:00 am, Licensing Program Analyst (LPA) Jeremey McClain met with Licensee Karen Petty for the purpose of a Licensee Initiated Case Management Inspection. No children were present during today’s inspection. All adults have obtained criminal record clearance.

The licensee has requested to have her Accessory Dwelling Unit (ADU) as the primary space for child care.

LPA made observations to the ADU. All hazardous items are inaccessible. LPA observed appropriate furnishings and equipment for children in care. LPA observed the required postings. LPA observed a functional smoke detector and 2A10BC Fire extinguisher, however a carbon monoxide detector was not observed. A small kitchen and bathroom are included in the ADU. LPA observed adequate sanitation and cleaning supplies. Outside play space will remain accessible to children in care. Licensee wishes to make the primary home off limits. Licensee stated that she does not provide care for infants at this time.

The ADU is equipped with a heating and air window unit. Windows are also available for egress. Licensee stated that the ADU building was permitted by the county, and she will send proof of permit to LPA.

Upon proof of a functional carbon monoxide detector, the licensee’s request will be approved.

LPA did not observe any violations of Title 22 Regulations during today’s inspection.

This report was reviewed with the license. LPA provided a Notice of Site Visit, which must remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2021
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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