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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009162
Report Date: 06/14/2019
Date Signed: 06/14/2019 08:45:10 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:LE PETIT ELEPHANT NURSERYFACILITY NUMBER:
283009162
ADMINISTRATOR:PAL PINTACSI, MILLIFACILITY TYPE:
830
ADDRESS:2645 LAUREL STREETTELEPHONE:
(707) 690-8797
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:55CENSUS: 21DATE:
06/14/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Kerry Knight, DirectorTIME COMPLETED:
09:00 AM
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LPA Kevin O'Connell made an unannounced case Management inspection to amend, obtain signatures and deliver a report.
No title 22 deficiencies were cited today.
Notice of Site Visit to be posted for 30 days from today.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
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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