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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 553623036
Report Date: 07/22/2021
Date Signed: 07/22/2021 11:00:58 AM

Document Has Been Signed on 07/22/2021 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 250
SACRAMENTO, CA 95833
FACILITY NAME:WELTMER,NICOLEFACILITY NUMBER:
553623036
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
07/22/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Nicole WeltmerTIME COMPLETED:
11:15 AM
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Licensing program Analyst (LPA) Justin Denton met with the licensee Nicole Weltmer for the purpose of a capacity increase from 8 to 14 children. LPA common areas of the home that are accessible to children, today’s census included seven children. Also present was licensee's daughter. All adults in the home have been finger print cleared through Community Care Licensing.

Off-limit areas include: Upstairs, side yards, bottom bedroom, laundry room and garage. Licensee acknowledged that children may never enter these off-limit areas.

LPA observed a fire drill was conducted and documented within the past six months. The Fire Safety Inspection Clearance has been received from the Tuolumne County Fire Department and the home has been cleared for up to 14 children.

LPA observed a pool under construction on the side of the home. LPA discussed pool regulations with the licensee. A fence is under construction that will comply with Title 22 regulations. There was no water in the pool at this time.

Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

Effective today, 07/22/21, LPA is granting a license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children with 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 2 years old.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Justin L Denton
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2021
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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