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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 553601807
Report Date: 04/26/2023
Date Signed: 04/26/2023 12:57:19 PM

Document Has Been Signed on 04/26/2023 12:57 PM - 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:MCKAY, SUSANFACILITY NUMBER:
553601807
ADMINISTRATOR:MCKAY, SUSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 533-2871
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
04/26/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee, Susan McKayTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Tobias Lake met with Licensee, Susan McKay on April 26, 2023 at 12:00pm for the purpose of an unannounced plan of correction inspection to clear a Type A and Type B deficiency, which was issued on 4/12/23, for an opened pool gate and soiled crib bedding.

During today's inspection LPA toured all areas accessible to children in care and observed four children being supervised by the Licensee. Licensee's staff and son were present during inspection. LPA reminded Licensee of the need to ensure the pool gates remain closed and that bedding used is clean and fitted properly. LPA reviewed the LIC 9224 acknowledgment forms signed by parents.

Deficiencies cited on 4/12/23 are cleared effective today. Proof of correction letter was provided. Notice of Site Visit was posted. This report was reviewed and discussed with the Licensee.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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