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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621667
Report Date: 07/26/2023
Date Signed: 07/26/2023 10:07:50 AM

Document Has Been Signed on 07/26/2023 10:07 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PIEDMONT, MARLENEFACILITY NUMBER:
343621667
ADMINISTRATOR:PIEDMONT, MARLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 358-9865
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
07/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Marlene PiedmontTIME COMPLETED:
10:30 AM
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Licensing Program Analyst Jennifer Velasco (LPA) conducted a case management visit for the purpose of updating recently produced documents. LPA met with Licensee Marlene Piedmont (L1) and reviewed this report, conducted an exit interview, and provided L1 with a Notice of Site visit to be posted in the facility for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2023
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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