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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
053613073
Report Date:
08/05/2019
Date Signed:
08/05/2019 10:44:25 AM
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:
GARANT, MICHELLE
FACILITY NUMBER:
053613073
ADMINISTRATOR:
GARANT, MICHELLE
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(209) 772-7267
CITY:
VALLEY SPRINGS
STATE:
CA
ZIP CODE:
95252
CAPACITY:
14
CENSUS:
8
DATE:
08/05/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:30 AM
MET WITH:
Michelle Garant
TIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Justin Denton conducted an unannounced visit at the facility in order to do an amended report. LPA met with Licensee Michelle Garant.
Notice of Site visit posted and appeal rights provided.
SUPERVISOR'S NAME:
Jeanne Smith
TELEPHONE:
(916) 208-4405
LICENSING EVALUATOR NAME:
Justin L Denton
TELEPHONE:
(916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE:
08/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/05/2019
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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