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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340320736
Report Date: 09/02/2021
Date Signed: 09/02/2021 01:45:02 PM

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: 13DATE:
09/02/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kelly PettigrewTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Christopher Bello and Alize Tillery arrived at the facility to clear a deficiency cited on 7/23/21 at approximately 9:30am. LPAs met with Teacher Kelly Pettigrew. LPAs observed two teachers and aide with 13 preschool children placing the facility in Teacher-Child Ratio. LPAs cleared the deficiency and provided Letter of Deficiency Citations Cleared. There were no Title 22 deficiencies during today’s investigation. An exit interview was conducted and a Notice of Site Visit posted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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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