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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701198
Report Date: 07/28/2023
Date Signed: 07/28/2023 11:00:28 AM

Document Has Been Signed on 07/28/2023 11:00 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.270
SACRAMENTO, CA 95833
FACILITY NAME:BRENDA'S PLACEFACILITY NUMBER:
392701198
ADMINISTRATOR:MCCARTHY, BRENDAFACILITY TYPE:
740
ADDRESS:408 VALDAPENA COURTTELEPHONE:
(209) 403-2944
CITY:ESCALONSTATE: CAZIP CODE:
95320
CAPACITY: 6CENSUS: 0DATE:
07/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Brenda McCarthyTIME COMPLETED:
11:10 AM
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On 7/28/23 at approximately 10am Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required annual inspection. LPA Jensen met with Licensee Brenda McCarthy and explained the purpose of today's visit. The Licensee explained there are currently no clients at the facility therefore the facility was offered for use as temporary shelter for a family friend that was evacuated due to fire. The occupants will be vacating around or on 8/10/23 and they anticipate accepting residents again by mid or late August.

LPA Jensen toured the grounds and determined them to be well maintained. All pathways on the grounds were observed to be clear of obstruction. There are no bodies of water on the property. All window screens were observed to be in good repair. The grounds have shaded areas and outdoor patio furniture for use by the clients.

LPA Jensen toured the interior of the facility and verified that there are currently no residents in care. Technical assistance was provided on the inspection authority of the licensing agency.

This annual will be continued and completed when the facility has resumed serving clients so that a thorough and comprehensive assessment can be conducted.

No citations were issues at this time. An exit interview was conducted and a copy of this report and the
LIC 9102 was provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2023
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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