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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619183
Report Date: 11/19/2021
Date Signed: 11/19/2021 01:36:11 PM

Document Has Been Signed on 11/19/2021 01:36 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:TAYLOR, FELICIAFACILITY NUMBER:
343619183
ADMINISTRATOR:TAYLOR, FELICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 996-1053
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
11/19/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Felicia TaylorTIME COMPLETED:
01:40 PM
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On 11/19/21, Licensing Program Analyst (LPA) Jan Hoshida and Detective Jorge Benitez met with Licensee Felicia Taylor for an unannounced Case Management Inspection regarding an unusual incident that occurred at the facility.

Upon arrival, LPA observed four children with Licensee's assistant/husband. During today’s inspection, LPA and Detective conducted interviews related to the incident.

At this time, no Title 22 Deficiencies were issued. LPA reviewed and provided copy of report with the Licensee. LPA provided Licensee with a Notice of Site Visit provided which must remain posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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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