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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343608969
Report Date: 06/08/2023
Date Signed: 06/08/2023 01:47:23 PM


Document Has Been Signed on 06/08/2023 01:47 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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:RALPH RICHARDSON PRESCHOOLFACILITY NUMBER:
343608969
ADMINISTRATOR:NOEL LESSARDFACILITY TYPE:
850
ADDRESS:4848 COTTAGE WAYTELEPHONE:
(916) 971-7411
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:72CENSUS: 0DATE:
06/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Stacey ShoreyTIME COMPLETED:
02:00 PM
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On June 8, 2023 at approximately 12:30 PM Licensing Program Analysts Josiah Gathing and Pa Dao Vang met with Preschool Administrator Stacey Shorey for the purpose of an unannounced Case Management investigation. The purpose of this inspection was to follow up on a self reported incident submitted to the Licensing program on June 1, 2023. During today's investigation LPAs conducted interviews, made observations, and collected documentation. The investigation did not result in any deficiencies cited.

A copy of this report was reviewed and provided to the Preschool Administrator. Appeal rights and a notice of site visit were provided.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah GathingTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023
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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