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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623515
Report Date: 07/14/2020
Date Signed: 07/14/2020 12:30:53 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:LITTLE SUMMIT CENTERFACILITY NUMBER:
343623515
ADMINISTRATOR:CAMERINO, C/RAMIREZ, CFACILITY TYPE:
850
ADDRESS:2224 BEAUMONT STREETTELEPHONE:
(916) 922-1896
CITY:SACRAMENTOSTATE: CAZIP CODE:
95815
CAPACITY:68CENSUS: 0DATE:
07/14/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Celaine CamerinoTIME COMPLETED:
11:30 AM
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Application Specialist (AS) Seychelle De Luca met with Applicant Celaine Camerino for the purpose of a second announced prelicensing tele-inspection (due to COVID-19).

AS and Applicant conducted a tour of the entire facility. AS verified the remaining equipment and furniture has arrived and all the classrooms are set up. AS verified there are first aid kits in each classroom.

This facility evaluation report was reviewed and discussed with Applicant. AS emailed a copy of the 809 to Applicant. Applicant understand she must read the report and send back an acknowledgement that she read and received the report.

Effective today, AS is granting a provisional license that will expire in 90 days on October 12, 2020.

CONDITIONS REQUIRING CORRECTION PRIOR TO EXPIRATION OF THE PROVISIONAL LICENSE:


1. Applicant will send AS the completed eight hour Preventative Health and Safety course, which includes lead prevention component.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De LucaTELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2020
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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