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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
343618727
Report Date:
08/01/2023
Date Signed:
08/01/2023 12:25:35 PM
Document Has Been Signed on
08/01/2023 12:25 PM
- 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:
HOLT, PRISCILLA
FACILITY NUMBER:
343618727
ADMINISTRATOR:
HOLT, PRISCILLA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(916) 444-0627
CITY:
SACRAMENTO
STATE:
CA
ZIP CODE:
95822
CAPACITY:
14
CENSUS:
0
DATE:
08/01/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:00 PM
MET WITH:
Priscilla Holt
TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Christopher Bello and Office Technician Yvonne Flores arrived at the facility for a Case Management inspection. Upon arrival licensee stated that she is no longer interested in her daycare license. Effective 8/1/2023 LPA will close the license.
SUPERVISOR'S NAME:
Amanda Blesi
TELEPHONE:
(916) 208-3427
LICENSING EVALUATOR NAME:
Christopher Bello
TELEPHONE:
(916) 862-0844
LICENSING EVALUATOR SIGNATURE:
DATE:
08/01/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/01/2023
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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