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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340320736
Report Date: 07/30/2021
Date Signed: 07/30/2021 11:53:49 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:POPPY PATCH-PHASE IIFACILITY NUMBER:
340320736
ADMINISTRATOR:DOROTHEA JACKSONFACILITY TYPE:
850
ADDRESS:9645 BUTTERFIELDTELEPHONE:
(916) 845-6033
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY:60CENSUS: 14DATE:
07/30/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jennifer WygandTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Christopher Bello and Mai Lor arrived at the facility to clear deficiencies cited on 7/23/21. LPAs observed at approximately 10:31am one teacher with 14 children. This is considered as a immediate risk to the children in care and the violation was not corrected. A Civil Penalty for a failure to correct was assessed. Interviews revealed that Director is not spending sufficient time in the facility. This violation was not corrected and is considered as a immediate risk to the children in care. A Civil Penalty for a failure to correct was assessed. An exit interview was conducted and appeal rights provided.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
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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