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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621826
Report Date: 07/07/2021
Date Signed: 07/07/2021 11:28:32 AM

Document Has Been Signed on 07/07/2021 11:28 AM - It Cannot Be Edited

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:SEQUOIA CHRISTIAN PRESCHOOLFACILITY NUMBER:
393621826
ADMINISTRATOR:BAUGH, CARMENFACILITY TYPE:
850
ADDRESS:1050 S. UNION ROADTELEPHONE:
(209) 815-9341
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 68TOTAL ENROLLED CHILDREN: 0CENSUS: 37DATE:
07/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Carmen BaughTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Christopher Jackson met with Carmen Bough, Director, for a Case Management Inspection. Purpose of the inspection was to follow up on an Unusual Incident Report the Department had received on July 6, 2021.

LPA toured the facility inside and outside, observed the care and supervision of children, and conducted interviews.


An exit interview was conducted and a notice of site visit was printed and posted.
SUPERVISORS NAME: Sharon Ogbodo
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2021
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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