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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610266
Report Date: 11/19/2021
Date Signed: 11/19/2021 02:28:07 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:CADENCE EDUCATION LLC - CLARKSVILLEFACILITY NUMBER:
343610266
ADMINISTRATOR:HAINES, SANDRAFACILITY TYPE:
850
ADDRESS:76 CLARKSVILLE RD.TELEPHONE:
(916) 983-0224
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:180CENSUS: 102DATE:
11/19/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sandra HainesTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kelly Ferrara conducted an unannounced Case Management inspection at the facility and met with the Director Sandra Haines. The inspection was in response to an Unusual Incident Report that was received on November 18th, 2021 regarding an incident that took place on November 17th, 2021. During today's inspection, there were 102 preschool children in care being supervised by 15 teachers.

During the inspection, LPA interviewed Director and Staff #1 and learned more details regarding the incident. LPA was able to review a video clip of the incident.

Based on the interviews conducted and observation of the video, LPA determined that there was not enough evidence that a Title 22 violation occurred.

Exit interview was conducted and a copy of this report was left with the Director. Notice of site was provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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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