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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570305772
Report Date: 10/28/2024
Date Signed: 10/28/2024 10:38:21 AM

Document Has Been Signed on 10/28/2024 10:38 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ST. PAUL'S LUTHERAN PRESCHOOLFACILITY NUMBER:
570305772
ADMINISTRATOR/
DIRECTOR:		UPTON, CORRIEFACILITY TYPE:
850
ADDRESS:625 WEST GIBSON ROADTELEPHONE:
(530) 662-1935
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 46TOTAL ENROLLED CHILDREN: 46CENSUS: 21DATE:
10/28/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:director, Corrie UptonTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On 10/28/2024 at 10:00 AM, Licensing Program Analyst (LPA) Lauren Scott arrived at the facility for the purpose of an unannounced case management inspection. LPA interviewed a child for an incident unrelated to this facility. Upon arrival, LPA observed 21 children supervised by 4 staff. All individuals subject to criminal background review have obtained a criminal record clearance.

Based on the inspection, no citations have been issued. Exit interview conducted and report was reviewed with the director, Corrie Upton.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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