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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624432
Report Date: 10/12/2022
Date Signed: 10/12/2022 01:39:17 PM

Document Has Been Signed on 10/12/2022 01:39 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:GENIUS KIDS-ELK GROVE FLORIN ROAD CAMPUS(INF)FACILITY NUMBER:
343624432
ADMINISTRATOR:DHILLON, RENNUFACILITY TYPE:
830
ADDRESS:8065 ELK GROVE FLORIN RD #160TELEPHONE:
(510) 364-4033
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
10/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Michelle JenkinsTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 1:00 pm met with teacher, Michelle Jenkins, regarding an Unusual Incident that took place October 6, 2022. LPA interviewed staff regarding the incident.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the director and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the director understands it must remain posted for 30 days.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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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