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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624081
Report Date: 12/07/2023
Date Signed: 12/07/2023 11:43:43 AM

Document Has Been Signed on 12/07/2023 11:43 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:PINDAR, ASHLEYFACILITY NUMBER:
343624081
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
12/07/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Ashley PindarTIME COMPLETED:
11:45 AM
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On December 7, 2023, Licensing Program Analyst (LPA), Michelle Perez, met with licensee Ashley Pindar for the purpose of a case management visit. During today's visit, there were four children present, including the licensees infant child.

Licensee has requested to place the backyard to "on limits," for the children to utilize. Off limit area of the backyard, is the side yard, that is gated off from the remainder of the yard.

Children will have access to the backyard and licensee will be providing 100% supervision while children are outside.

Licensee is aware that any further changes to an on or off limit area, will require a visit from the LPA to be approved.

Effective today, 12/7/2023, licensee's backyard will be on limits for children.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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