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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610520
Report Date: 09/02/2021
Date Signed: 09/02/2021 01:45:46 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 IIIFACILITY NUMBER:
343610520
ADMINISTRATOR:TATE, SHANELFACILITY TYPE:
830
ADDRESS:9638 BUTTERFIELD WAYTELEPHONE:
(916) 845-4949
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY:60CENSUS: 19DATE:
09/02/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shanel TateTIME 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, 8/19/21 and 8/20/21 at approximately 10:15am. LPAs met with director Shanel Tate. LPAs observed two teachers and two aides with 14 toddlers and Shanel acting as an infant teacher with one aide with five infants. LPAs observed that the facility was in Teacher-Child ratio and had fully qualified staff with aides supervising the children. LPAs cleared the deficiencies regarding Teacher-Child ratio and staff qualifications. Per LPM Seychelle De Luca, LPAs cleared the deficiency cited on 7/23/21 regarding required Mandated Reporter Training and Required documentation of immunization's for MMR and TDAP. LPAs provided Letter of Deficiency Citations Cleared. 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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