<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
573610487
Report Date:
12/02/2022
Date Signed:
12/02/2022 11:58:43 AM
Document Has Been Signed on
12/02/2022 11:58 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
,
2525 NATOMAS PARK DR. STE 250
SACRAMENTO
,
CA
95833
FACILITY NAME:
COOK, STEPHANIE
FACILITY NUMBER:
573610487
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
4
DATE:
12/02/2022
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
11:56 AM
MET WITH:
licensee, Stephanie Cook
TIME COMPLETED:
12:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
SUPERVISORS NAME
:
Chayntel Hunter
LICENSING EVALUATOR NAME
:
Lauren Scott
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/02/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
4