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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614437
Report Date: 01/10/2024
Date Signed: 01/10/2024 10:06:18 AM

Document Has Been Signed on 01/10/2024 10:06 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KOHLER PRESCHOOLFACILITY NUMBER:
343614437
ADMINISTRATOR:NICOLE SCHLIEFACILITY TYPE:
850
ADDRESS:4004 BRUCE WAYTELEPHONE:
(916) 566-1850
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 29DATE:
01/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Brittany SamayoaTIME COMPLETED:
10:10 AM
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On Wednesday, January 10, 2024 at 8:30 AM, Licensing Program Analyst (LPA) Tanya Washington met with Facility Representative Brittany Samayoa for an unannounced case management inspection regarding a self- reported unusual incident which was submitted to Community Care Licensing on 12/22/2023. Shortly after LPAs arrival Nicole Schlie (Program Coordinator) arrived to the facility to assist LPA. During today's inspection, LPA toured both full and part day classrooms and observed care and supervision of 29 children supervised by nine staff.
LPA conducted interviews with staff, children and obtained copies of some records.

No deficiencies are cited during today's inspection.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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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