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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623263
Report Date: 10/10/2023
Date Signed: 10/10/2023 11:54:14 AM

Document Has Been Signed on 10/10/2023 11:54 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HAYWARD, TERRIEFACILITY NUMBER:
343623263
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
10/10/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Terrie HaywardTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Perez, met with licensee, Terrie Hayward, for the purpose of a case management visit to increase licensees capacity to a large family childcare home.
Upon arrival LPA observed four children in care, supervised by the licensee and two assistants.

Off limits areas: Entire upstairs

LPA toured the facility and observed all changes that were required to be completed, per the Fire Department.
LPA discussed CCR Regulation 102416.5 regarding staffing Ratio and Capacity for a large license.

Effective today, 10/10/2023, the facility is approved for a large capacity to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years.



Notice of site visit was provided and will be posted for 30 days
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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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