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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621719
Report Date: 04/25/2024
Date Signed: 04/25/2024 03:10:18 PM

Document Has Been Signed on 04/25/2024 03:10 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:VINELAND PRESCHOOLFACILITY NUMBER:
343621719
ADMINISTRATOR/
DIRECTOR:		NICOLE SCHLIEFACILITY TYPE:
850
ADDRESS:6450 20TH STREETTELEPHONE:
(916) 566-1616
CITY:RIO LINDASTATE: CAZIP CODE:
95673
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 18DATE:
04/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Amanda AllensworthTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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On Thursday, April 25, 2024, Licensing Program Analyst (LPA) Lea Habtom arrived at Vineland Preschool for a case management inspection. The purpose of today's inspection is in response to the self reported unusual incident received on April 8, 2024. LPA L. Habtom conducted staff interviews and determined that no Title 22 regulations were violated.

There was a census of 18 preschool children being supervised by 5 staff. All staff present today have fingerprint clearances and associations.

This report was reviewed with designated staff member, Amanda Allensworth. A notice of site visit was provided to be posted for 30 days. Appeal rights provided.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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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