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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623141
Report Date: 02/28/2020
Date Signed: 02/28/2020 03:10:33 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:CREATIVE SPIRIT LEARNING CENTERFACILITY NUMBER:
343623141
ADMINISTRATOR:BRANN, NICOLEFACILITY TYPE:
850
ADDRESS:10729 FAIR OAKS BLVDTELEPHONE:
(916) 967-7883
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:24CENSUS: 14DATE:
02/28/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Nicole BrannTIME COMPLETED:
03:20 PM
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Licensing Program Analyst Lea Habtom met with director Nicole Brann for the purpose of an unannounced visit to amend the case management report filed on February 27, 2020. The amended reporter was signed and provided to the director.

Today's census is 14 children supervised by 2 staff members.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
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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