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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621225
Report Date: 04/30/2020
Date Signed: 05/01/2020 01:55:15 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:OAK PARK PRESCHOOL INC. IIFACILITY NUMBER:
343621225
ADMINISTRATOR:CURRIE, ARCYFACILITY TYPE:
850
ADDRESS:4036 14TH AVENUETELEPHONE:
(916) 737-7064
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:30CENSUS: 10DATE:
04/30/2020
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sharon SimmonsTIME COMPLETED:
01:30 PM
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On 04/30/2020, approximately at 12:30 PM, Licensing Program Analyst Tanya Washington contacted Site Supervisor Sharon Simmons for a tele-inspection regarding a self reported unusual incident which occurred on 03/12/2020. Due to COVID-19 pandemic the visit is conducted via face-time call. During today's tele- inspection there were 10 children in care supervised by 2 staff and Site Supervisor.

In lieu of Site Supervisor's signature, LPA Washington is e-mailing the report with a read receipt request.

No Title 22 deficiencies cited pertaining to the reported incident. Notice of site visit sent to Site Supervisor via e-mail.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2020
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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