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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343601694
Report Date: 04/08/2022
Date Signed: 04/08/2022 12:59:51 PM


Document Has Been Signed on 04/08/2022 12:59 PM - 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:KIDS COMPANY PRESCHOOL & CHILDCARE CENTERFACILITY NUMBER:
343601694
ADMINISTRATOR:WILLETTE, ROBINFACILITY TYPE:
850
ADDRESS:3850 CALIFORNIA AVE.TELEPHONE:
(916) 944-0706
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:45CENSUS: 29DATE:
04/08/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Shayna Gordon-JonesTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Alize Tillery arrived at the facility at approximately 12:30 PM, to clear deficiencies cited on 2/11/2022. LPA met with Director Shayna Gordon-Jones. LPA observed 29 children, supervised by 3 staff.

During today's visit, LPA reviewed staff files; staff files were observed to be complete. Director is aware of which documents are to be kept in all staff personnel file.

Today, LPA Tillery is clearing citation 101217(a).

In the areas that were observed, no deficiencies were cited. An exit interview was conducted and a Notice of Site Visit was provided.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022
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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