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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293621897
Report Date: 08/12/2021
Date Signed: 08/12/2021 11:19:11 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:PLAY DATE PRESCHOOL & DAYCAREFACILITY NUMBER:
293621897
ADMINISTRATOR:ROSS, TYLERFACILITY TYPE:
850
ADDRESS:10114 DORCHESTER DR, SUITE 101TELEPHONE:
(530) 798-1971
CITY:TRUCKEESTATE: CAZIP CODE:
96161
CAPACITY:42CENSUS: 15DATE:
08/12/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Tyler Ross - LicenseeTIME COMPLETED:
11:30 AM
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On Thursday, August 12th, 2021, at 10:31am, Licensing Program Analyst (LPA) Blake Morillas and Licensing Program Manager (LPM) Keven Peters met with the Licensee, Tyler Ross, for the purpose of a Case Management Visit. At 10:32am, 15 preschool age children and three staff were observed.

The purpose of the Case Management visit was to discuss the ongoing and future plans of operation of the center with the Licensee.

At 11:10am, LPA reviewed and discussed this facility Case Management report with the Licensee.

LPA provided a Notice of Site Visit and the Licensee acknowledges that this notice shall remain posted for 30 days for parental review.

The Licensee was provided a copy of the Appeal Rights (LIC9058) and the Licensee's signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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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