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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619102
Report Date: 03/03/2022
Date Signed: 03/03/2022 09:50:40 AM

Document Has Been Signed on 03/03/2022 09:50 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:ALEXANDER, PATRICIAFACILITY NUMBER:
343619102
ADMINISTRATOR:ALEXANDER, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 691-6821
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Patricia AlexanderTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Christopher Jackson and Regional Manager (RM) Sharon Ogbodo met with Licensee, Patricia Alexander for the purpose of a case management inspection. Census at the time of inspection was seven children.

The purpose of today's inspection is to deliver the Immediate Civil Penalty Assessment - Serious Bodily Injury/Physical Abuse citation of $2000 for a personal rights citation dated 10/27/21.

Mrs. Alexander was given her appeal rights. No deficiencies were cited during today's inspection. Notice of Site Visit was provided.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2022
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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