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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620703
Report Date: 05/23/2022
Date Signed: 05/23/2022 12:48:35 PM


Document Has Been Signed on 05/23/2022 12:48 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:PADILLA, ANNFACILITY NUMBER:
343620703
ADMINISTRATOR:PADILLA, ANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 856-2766
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY:14CENSUS: 4DATE:
05/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Ann PadillaTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with licensee, Ann Padilla, for a case management inspection. The purpose of the inspection was explained. Present, there are four children in care with licensee and one helper.

On May 17, 2022, the licensee self reported an incident of a child having medical emergency and medical services were contacted. During today’s inspection, LPA interviewed the licensee about the incident and inspected the day care areas. During inspection, LPA took pictures of child’s records. During the licensee’s interview, it was found that a child was napping more than usual nap routine of the child. Per licensee, as licensee was observing the child, licensee did not feel normal and contacted the medical emergency response team. The child was taken to the hospital. The child has been release from the hospital and back at child’s home. The child will be returning in care tomorrow (May 24, 2022). During inspection and interview, LPA did not observe any violation of any child care regulations.

Copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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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