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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614793
Report Date: 11/01/2022
Date Signed: 11/01/2022 10:07:16 AM


Document Has Been Signed on 11/01/2022 10:07 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:WILLIAM DAYLORFACILITY NUMBER:
343614793
ADMINISTRATOR:MARTENS, TOMFACILITY TYPE:
850
ADDRESS:6131 ORANGE AVENUETELEPHONE:
(916) 427-2637
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:24CENSUS: 0DATE:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Arnold AllenTIME COMPLETED:
10:30 AM
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Licensing Program Analysts (LPAs) Gagandeep SIngh and David Nguyen meet with school vice principal, Arnold Allen, for annual inspection. Purpose of the inspection was explained. During today's inspection, no children were present.

During the inspection, school vice principal informed that the school will not be operating the child care in room 5 for this school year. During today's inspection, LPAs inspected the classroom. LPA observed the classroom has license and all of the other required documents posted. The classroom has carbon monoxide detector, smoke detector, working telephone and first aid supplies available. There is fully charged fire extinguisher available on site. LPA observed there is age appropriate play structure in the play yard.

Copy of this report was reviewed and provided to the facility representative. Notice of site visit was posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2022
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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