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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622676
Report Date: 08/30/2022
Date Signed: 08/30/2022 02:44:01 PM

Document Has Been Signed on 08/30/2022 02:44 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:DAVIS, TRACEYFACILITY NUMBER:
343622676
ADMINISTRATOR:DAVIS, TRACEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 942-9089
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
08/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Tracey DavisTIME COMPLETED:
02:45 PM
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A case management inspection was conducted by Licensing Program Analysts Mandie Goodwin and Jennifer Velasco (LPAs), who met with Licensee Tracey Davis (L1) regarding a report provided to the Department. During today's inspection, LPAs toured the facility, reviewed facility documents, and observed L1 providing care to three children.

No deficiencies were cited during this inspection. This report was reviewed and discussed with L1. Appeal Rights were provided and exit interview was conducted. All licensing reports are public information and must be made available upon request for at least three years. L1 was provided with a Notice of Site Visit (NOS) to be posted in the facility for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
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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