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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623370
Report Date: 11/22/2021
Date Signed: 11/22/2021 10:46:03 AM

Document Has Been Signed on 11/22/2021 10:46 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:KILMER, ADRIANNAFACILITY NUMBER:
343623370
ADMINISTRATOR:KILMER, ADRIANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 228-1489
CITY:SACRAMENTOSTATE: CAZIP CODE:
95864
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
11/22/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adrianna KilmerTIME COMPLETED:
11:00 AM
NARRATIVE
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On Monday, 11/22/21, Licensing Program Analyst (LPA) Jan Hoshida conducted an unannounced Annual Continuation inspection for the Annual Inspection that was conducted on 11/08/2021. LPA met with Licensee Adrianna Kilmer. LPA observed there were five day care children present in the facility during this inspection with Licensee and Licensee's Assistant.

LPA toured the home and inspected the storage of weapons in the home. LPA observed that the gun and ammunition were stored and locked separately and in compliance with Title 22 regulations and the Health and Safety Code.

LPA consulted Licensee regarding the Safe Sleep regulations for children under the age of two years. LPA provided Licensee with PIN 20-24-CCP and Individual Infant Sleeping Plan LIC9227.

In the areas that were evaluated, no deficiencies were observed at the time of the visit. Appeal rights discussed, exit interview conducted and Notice of Site Visit was posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2021
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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