<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010212
Report Date: 07/15/2022
Date Signed: 07/15/2022 03:14:04 PM

Document Has Been Signed on 07/15/2022 03:14 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:PENROSE, CHRISTINA FCCHFACILITY NUMBER:
493010212
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Christina PenroseTIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Glenn Ouye met with applicant Christian Penrose to conduct a prelicensing inspection. The applicant submitted the application on May 20, 2022. There is an exemption that is in progress but is not finalized as of today.

LPA Ouye toured the home.

There are several items that will need to be changed prior to licensure. The downstairs bathroom medicine cabinet will need to be cleared of any items that need to be inaccessible. There are two kitchen drawers that the applicant will install child safety locks to make sharp objects inaccessible. The applicant will also install the child safety gate at the bottom of the stairs.

LPA will return and complete the prelicensing inspection when the items are addressed.

LPA will determine with the applicant when the inspection can be completed.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1