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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619123
Report Date: 03/22/2023
Date Signed: 03/22/2023 11:46:10 AM


Document Has Been Signed on 03/22/2023 11:46 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:ABDULLAH, CHARMAINEFACILITY NUMBER:
343619123
ADMINISTRATOR:ABDULLAH, CHARMAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 739-1599
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:14CENSUS: 4DATE:
03/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Christine LeeTIME COMPLETED:
11:50 AM
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On March 22, 2023 at 11:25 AM, Licensing Program Analyst (LPA) Tanya Washington met with Licensee's Assistant Christine Lee for an unannounced case management inspection to clear a citation which was issued on 03/01/2023 for ratios. During today's inspection LPA observed care and supervision of one infant and three preschool age children supervised by Ms. Lee. The licensee was not present at the facility during the inspection, LPA spoke to Licensee on the phone, she stated she was running an errand and will be back soon. LPA reviewed LIC9224 forms which were observed in all children's files.

LPA printed out a letter of cleared citation. Notice of site visit posted and shall remain posted for the next 30 days. This report was reviewed with Christine Lee.

Exit interview conducted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
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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