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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343611191
Report Date: 08/30/2019
Date Signed: 08/30/2019 10:27:07 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:GARDEN VALLEY SCHOOLFACILITY NUMBER:
343611191
ADMINISTRATOR:VANG, MAIFACILITY TYPE:
850
ADDRESS:3601 LARCHWOOD DRIVETELEPHONE:
(916) 643-8750
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:24CENSUS: 10DATE:
08/30/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jonelyn YountTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Christopher Bello met with Teacher Jonelyn Yount regarding an Unusual Incident that took place on August 21st, 2019. LPA interviewed Jonelyn regarding the incident.

LPA inspected the area where the incident occurred and did not observe any sharp wires but did observe a protruding bolt from the gate. Jonelyn stated that there is a work order to fix the bolt in a manner to prevent future incidents.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the director and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the director understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019
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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