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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 554500150
Report Date: 05/28/2021
Date Signed: 05/28/2021 01:24:21 PM

Document Has Been Signed on 05/28/2021 01:24 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:MACDONALD, CARRIE ELIZABETHFACILITY NUMBER:
554500150
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
05/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Carrie MacDonaldTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Justin Denton met with the Licensee Carrie MacDonald for the purpose of a capacity increase from 8 to 14 children. LPA toured all areas of the home that are accessible to children, today’s census included four children. All adults in the home have been finger print cleared through Community Care Licensing. This inspection was conducted over video-chat due to the COVID-19 pandemic.

Off-limit areas currently include: entire upstairs, workshop, son's bedroom, small hallway room, and car port. Licensee acknowledged that children may never enter these off-limit areas. Licensee is converting her son's bedroom and small hallway room to on-limits with the intent of using those areas for naps. LPA viewed those areas over video-chat. Licensee ensure that a high placed fuse box in the small hallway room is inaccessible to children. LPA viewed it covered by a shelf. If the shelf is removed, Licensee MacDonald agreed to install a safety latch and ensure the box remains closed.

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.

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 Tuesday, 06/01/21, 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: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2021
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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