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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618892
Report Date: 10/08/2020
Date Signed: 10/09/2020 08:49:44 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:CASEY, DAVENAFACILITY NUMBER:
343618892
ADMINISTRATOR:CASEY, DAVENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 796-3593
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:14CENSUS: 12DATE:
10/08/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Davena CaseyTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Christopher Bello had a Tele-inspection with licensee Davena Casey for a Case Management Licensee Initiated inspection via the FaceTime application. Today’s inspection regarded adding a room to the on-limits portion to their facility. At time of inspection there was 12 children. Also present was licensee’s assistant. LPA inspected the room and approves the room for daycare use.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed and sent a copy of the report via email. Licensee sent an email back confirming that she received the report acting as her virtual signature. LPA also sent a copy of the Notice of Site visit that must be posted for 30days and appeal rights.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020
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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