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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603168
Report Date: 05/28/2019
Date Signed: 05/28/2019 10:38:11 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:ELLEN FEICKERT SCHOOL AGE CDCFACILITY NUMBER:
343603168
ADMINISTRATOR:YOGI, GERALDINEFACILITY TYPE:
840
ADDRESS:9351 FEICKERT DRIVETELEPHONE:
(916) 686-6499
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:70CENSUS: 0DATE:
05/28/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Geraldine YogiTIME COMPLETED:
10:55 AM
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Licensing Program Analysts (LPAs) Amy Silva and Joleen Kenney conducted a case management inspection and met with the Site Supervisor, Geraldine Yogi. The purpose of today's inspection was to obtain signatures and deliver the report for the inspection that was previously conducted on May 23, 2019. The report was not able to be generated or printed on the date of the inspection due to computer issues.

No deficiencies were observed or cited during today's inspection. Notice of Site Visit was provided posted.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2019
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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