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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500368
Report Date: 12/08/2021
Date Signed: 12/08/2021 03:22:24 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 LONDON MONTESSORIFACILITY NUMBER:
344500368
ADMINISTRATOR:GODAMUNNE, TAZMINFACILITY TYPE:
850
ADDRESS:9209 TRENHOLM DRTELEPHONE:
(916) 548-2051
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:30CENSUS: 12DATE:
12/08/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:39 PM
MET WITH:Tazmin GodamunneTIME COMPLETED:
03:27 PM
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On 12/08/2021 at 2:39 PM Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted an unannounced case management inspection and met with Licensee, Tazmin Godamunne. The purpose of the inspection was to discuss an alleged incident that reported to Community Care Licensing by the facility. During the inspection 12 preschool age children were in care being supervised by one staff person. LPA conducted interviews with children in care.

At this time no citations were given and an exit interview was conducted. Notice of site visit was provided and posted. This shall be posted for 30 days.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
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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