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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622790
Report Date: 06/23/2021
Date Signed: 06/23/2021 09:35:21 AM

Document Has Been Signed on 06/23/2021 09:35 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:LEVIN, SHELLEY & IANFACILITY NUMBER:
343622790
ADMINISTRATOR:LEVIN, SHELLEY & IANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 773-2853
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
06/23/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Shelley and Ian LevinTIME COMPLETED:
09:40 AM
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On June 23, 2021 at 9:10 AM Licensing Program Analyst (LPA) Tanya Washington met with Shelley and Ian Levin for an unannounced case management inspection. During today's visit LPA observed care and supervision of 7 preschool children supervised by both Licensees, also present is Licensees minor child.

Licensee stated that their current hours of operation are Monday- Thursday from 8 AM to 3:30 PM and Friday's from 8 AM to 1 PM.

Prior to today's inspection Licensee contacted LPA and informed her that they are planning to install a seasonal above ground pool.

During today's inspection LPA observed an above ground pool surrounded by a five foot mesh fence. There is a gate which is self closing, self latching and swings away from the pool. Pool fencing during today's inspection meet Title 22 regulations.

Licensee stated that the pool and the fence will be put away sometime in September and will be set up sometime in March of next year.

Licensee understands that the pool fence must be sturdy and in good repair.

The children's play area is separated by a short picket fence and Licensee stated that the children don't enter the area where the pool is located.

Notice of site visit posted. No deficiencies are observed.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2021
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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