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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340305266
Report Date: 05/16/2022
Date Signed: 05/16/2022 10:23:37 AM


Document Has Been Signed on 05/16/2022 10:23 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:SUTTERVILLE PRESCHOOL, INC.FACILITY NUMBER:
340305266
ADMINISTRATOR:TOZER, KIMFACILITY TYPE:
850
ADDRESS:5520 GILGUNN WAYTELEPHONE:
(916) 455-9420
CITY:SACRAMENTOSTATE: CAZIP CODE:
95822
CAPACITY:40CENSUS: 23DATE:
05/16/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Jenny RuffaineTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 9:10am for a Plan of Correction inspection regarding the deficiencies cited on LIC809D dated 5/12/22. LPA met with Co-director, Jenny Ruffaine. Today’s census was 23 children with three teachers and four parent volunteers.

Based upon today’s inspection, LPA’s observed that the deficiency is cleared as of today.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the director and provided copies. An exit interview was conducted. LPA observed the Notice of Site Visit posted and the director understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2022
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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