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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
343619766
Report Date:
08/14/2024
Date Signed:
08/14/2024 08:57:11 AM
Document Has Been Signed on
08/14/2024 08:57 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:
FOLSOM EDUCATIONAL ACADEMY
FACILITY NUMBER:
343619766
ADMINISTRATOR:
ELSAWAF, FATMA
FACILITY TYPE:
850
ADDRESS:
381 SOUTH LEXINGTON DR, #100
TELEPHONE:
(916) 790-8599
CITY:
FOLSOM
STATE:
CA
ZIP CODE:
95630
CAPACITY:
27
CENSUS:
21
DATE:
08/14/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
08:45 AM
MET WITH:
Dr. Fatma Elsawaf
TIME COMPLETED:
09:00 AM
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LPA attempted an annual inspection but had to leave due to scheduling conflict.
SUPERVISOR'S NAME:
Natalie Dunaway
TELEPHONE:
(916) 263-1414
LICENSING EVALUATOR NAME:
Jennifer Velasco
TELEPHONE:
707-953-7341
LICENSING EVALUATOR SIGNATURE:
DATE:
08/14/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/14/2024
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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