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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624916
Report Date: 10/23/2024
Date Signed: 10/23/2024 01:16:58 PM

Document Has Been Signed on 10/23/2024 01:16 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:MISSION AVENUE PRESCHOOLFACILITY NUMBER:
343624916
ADMINISTRATOR/
DIRECTOR:		CHRISTINA DIAZ BUSHMANFACILITY TYPE:
830
ADDRESS:2433 MISSION AVENUETELEPHONE:
(916) 487-4647
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 19TOTAL ENROLLED CHILDREN: 19CENSUS: 14DATE:
10/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Nicole Moran EstradaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On October 23, 2024 at approximately 11:00 AM Licensing Program Analyst (LPA) Josiah Gathing met with Director Nicole Moran-Estrada for an inspection. During the inspection, LPA was informed by the Director of an unusual incident that took place Friday, October 18, 2024. LPA made observations, collected documentation and interviewed the Director.

No deficiencies were cited during today's inspection. A notice of site visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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