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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317946
Report Date: 01/13/2022
Date Signed: 01/13/2022 10:16:19 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:EARL WARREN PRESCHOOLFACILITY NUMBER:
340317946
ADMINISTRATOR:HO, CHELSEAFACILITY TYPE:
850
ADDRESS:5420 LOWELL STREETTELEPHONE:
(916) 382-5934
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:48CENSUS: 4DATE:
01/13/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mary Adamis-VeirsTIME COMPLETED:
10:30 AM
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On Thursday, January 13, 2022 at 9:00 AM, Licensing Program Analyst Tanya Washington met with substitute teacher Mary Adamis-Veirs for a plan of correction inspection. This inspection is being conducted to clear type B citations issued on November 16, 2021 for incomplete children's records. Upon arrival LPA observed two staff supervising four children in classroom P1. Classroom P2 is closed for quarantine and will re-open next Tuesday 01/18/2022.

LPA conducted review of children's files and observed that all missing forms are now in the files. LPA printed out a letter of correction and provided it to teacher Adamis-Veirs.

There are no outstanding deficiencies at this time. Notice of site visit has been posted and shall remain posted for 30 days.

Exit interview was conducted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
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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