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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317924
Report Date: 02/23/2023
Date Signed: 02/23/2023 10:27:35 AM


Document Has Been Signed on 02/23/2023 10:27 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:JOHN BIDWELL PRESCHOOLFACILITY NUMBER:
340317924
ADMINISTRATOR:XIONG, CHAOFACILITY TYPE:
850
ADDRESS:1730 65TH AVENUETELEPHONE:
(916) 433-5451
CITY:SACRAMENTOSTATE: CAZIP CODE:
95822
CAPACITY:50CENSUS: 18DATE:
02/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Anjelle CarsonTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 8:45am and met with Instructional Aide Shelly Saelee. Approximately 30 minutes later Coordinator Anjelle Carson arrived at the facility. LPA was at the facility regarding an Unusual Incident that took place on February 2, 2023. LPA gathered documents regarding the incident.

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: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
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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