Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616766
Report Date: 12/09/2016
Date Signed 12/09/2016 09:24:38 AM

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:PERNETTI, ANDREAFACILITY NUMBER:
393616766
ADMINISTRATOR:PERNETTI, ANDREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 642-3288
CITY:RIPONSTATE: CAZIP CODE:
95366
CAPACITY:14CENSUS: 6DATE:
12/09/2016
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Andrea PernettiTIME COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) Bettina Engelman met with Andrea Pernetti, licensee, for a Proof of Corrections Visit to verify corrections of violations cited at the last visit. On 11/30/2016, a Type A deficiency was cited for staffing ratio and capacity, when licensee had 9 children in care. Prior to today’s visit, licensee had submitted a written plan on maintaining ratios and capacity.

LPAs toured the facility inside and outside and observed the care and supervision of children. During today’s visit, six children, including 1 infant, were present. Children’s files contained signed Acknowledgements of Receipt of Licensing Report Forms (LIC 9224). The Type A deficiency cited on 11/30/16 is cleared with today’s visit. No new deficiency was cited at today’s visit.

An Exit Interview was conducted, and a Notice of Site Visit was posted.

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Bettina EngelmanTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2016
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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