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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621081
Report Date: 02/11/2020
Date Signed: 02/11/2020 12:12:05 PM

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:LIL' SCHOOL, THEFACILITY NUMBER:
343621081
ADMINISTRATOR:THATCHER, STACIFACILITY TYPE:
840
ADDRESS:8089 MADISON AVE, #11TELEPHONE:
(520) 456-8234
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:40CENSUS: DATE:
02/11/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Gloria Rowe-JohnsonTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Karyn Guerra met with Director, Gloria Rowe-Johnson for an unannounced case management inspection regarding a self-reported incident reported to the department on 1/30/2020. During the inspection, LPA made observations and reviewed files. LPA also provided facility rosters for updating. No deficiencies were cited during today's inspection. An exit interview was conducted and a notice of site visit was posted.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
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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