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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573621481
Report Date: 01/31/2024
Date Signed: 01/31/2024 03:49:58 PM

Document Has Been Signed on 01/31/2024 03:49 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HODGE, TIFFANYFACILITY NUMBER:
573621481
ADMINISTRATOR:HODGE, TIFFANYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(618) 663-0574
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
01/31/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:licensee, Tiffany HodgeTIME COMPLETED:
04:00 PM
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On January 31, 2024 at 3:00PM, Licensing Program Analyst (LPA) Lauren Scott and Licensing Program Manager (LPM) Chayntel Hunter met with Licensee, Tiffany Hodge for the purpose of an unannounced case management inspection to serve a Temporary Suspension Order (TSO). LPA and LPM observed 14 children present in the home.

This report and the TSO documents were left with the licensee, Tiffany Hodge. The following documents were included in the TSO packet: (1) Order for Temporary Suspension of Licensee Prior to Hearing, (2) Statement to Respondent, (3) Government Code Sections, (4) Instructions for Licensee about the Summary of Charges, (5) Accusation (License Revocation), and (6) Request for Discovery and Notice of Defense (two copies). The licensee may not operate their Family Child Care Home after the close of business on January 31, 2024.

An exit interview was conducted and report was reviewed with the licensee, Tiffany Hodge. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A Temporary Suspension Order Notice (LIC 9031) was posted on the front door.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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