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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610520
Report Date: 09/24/2021
Date Signed: 09/24/2021 01:50:45 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:
09/24/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Shanel Tate TIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Alize Tillery arrived at the facility at approximately 1:00 PM, to clear deficiencies cited on 8/20/2021 and 9/2/2021. LPA met with Director Shanel Tate. LPA observed 5 infants - supervised by 2 staff and 14 napping toddlers - supervised by 2 staff. LPA observed the facility to be in Teacher-Child ration with a fully qualified teacher in each room.
LPA Tillery observed the Admission Agreement for the day care children. Director understands that a signed Admission Agreement is to be in each child's file. Director provided proof that a training was conducted in regards to reporting requirements. Director also provided proof that she is working on scheduling staff to take the mandatory CPR and First Aid Training on October 16, 2021.

Today, LPA Tillery is clearing citations 101226(a), 101219(a), and 1596.866.

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: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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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