<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340318374
Report Date: 10/03/2019
Date Signed: 10/03/2019 11:46:18 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:CORDOVA VILLA ELEMENTARY SCHOOLFACILITY NUMBER:
340318374
ADMINISTRATOR:CHAVEZ, AUNDRIAFACILITY TYPE:
850
ADDRESS:10460 REYMOUTH AVENUETELEPHONE:
(916) 366-6181
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:22CENSUS: 22DATE:
10/03/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Gee LorTIME COMPLETED:
12:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs), Jan Hoshida and Kelly Ferrar, met with Lead Teacher, Gee Lor, for an unannounced case management inspection. Upon arrival, LPAs observed 22 preschool children supervised by three staff members.

Director, Jacqueline Wyse, requested to have 28 students on the outside playground to have the flexibility of having the special education pre-Kindergarten students the opportunity for inclusion with the general education pre-Kindergarten students.

LPAs measured the outdoor playground space only. The outdoor playground area measured for 10,534.9156 square feet which can accommodate the requested usage for 28 children. As of today, 10/3/19, the facility is approved for an outdoor usage of 28 children to provide special education pre-Kindergarten students the opportunity for inclusion with the general education pre-Kindergarten students.

No deficiencies were cited in today’s visit. An exit interview was conducted and a Notice of Site Visit was posted.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1