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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293621374
Report Date: 07/07/2022
Date Signed: 07/07/2022 03:54:37 PM

Document Has Been Signed on 07/07/2022 03:54 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MILLER, HOLLIEFACILITY NUMBER:
293621374
ADMINISTRATOR:MILLER, HOLLIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 550-8783
CITY:TRUCKEESTATE: CAZIP CODE:
96161
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Hollie MillerTIME COMPLETED:
01:04 PM
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On July 7, 2022 at approximately 11:40am, LPA arrived unannounced to conduct a required annual inspection. Upon arrival there were 12 day care children present, including one child under two, and licensee's spouse who was the assistant today. Shortly after arrival, the facility was alerted the town of Truckee was under evacuation orders because of a nearby Forrest fire. Due to evacuation orders, the inspection will be completed at a later date.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2022
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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