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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619126
Report Date: 01/28/2022
Date Signed: 01/28/2022 10:44:39 AM

Document Has Been Signed on 01/28/2022 10:44 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:RADCLIFF, SHELLEYFACILITY NUMBER:
343619126
ADMINISTRATOR:RADCLIFF, SHELLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 524-4396
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Shelley RadcliffTIME COMPLETED:
11:00 AM
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On Friday, January 28, 2022, Licensing Program Analyst Tanya Washington met with Licensee, Shelley Radcliff for an unannounced case management inspection. Licensee informed LPA that she stopped watching children in August, 2021.

Licensee stated that at this time she wishes to go on inactive status effective today 01/28/2022 until 01/28/2023.

Licensee agrees to follow the conditions of inactive status and is aware that if she enrolls more than one unrelated family she would need to activate her license.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2022
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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