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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621826
Report Date: 04/30/2024
Date Signed: 04/30/2024 02:18:44 PM

Document Has Been Signed on 04/30/2024 02:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SEQUOIA CHRISTIAN PRESCHOOLFACILITY NUMBER:
393621826
ADMINISTRATOR/
DIRECTOR:		CARMEN BAUGHFACILITY TYPE:
850
ADDRESS:1050 SOUTH UNION ROADTELEPHONE:
(209) 815-9341
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 68TOTAL ENROLLED CHILDREN: 68CENSUS: 55DATE:
04/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Carmen BaughTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analysts (LPAs) Lauren Scott and Janie Davis met with Director, Carmen Baugh to follow up on two Unusual Incident Reporst (UIR) submitted to Community Care Licensing on 04/16/2024 and 04/23/2024.

The facility reported the UIR to Community Care Licensing within 24hrs. A written UIR was submitted within 7 days, describing the specifics of the incident.

LPAs toured the facility and interviewed staff. LPAs reviewed and discussed this report with the director.

Through a physical walk through, it was noticed that the facility play structure age requirement is for children 5-12 years old. This was discussed with the director, and determined that the structure would be made off limits for all children whom are not of age.

Facility evaluation report was reviewed and discussed with director. Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Janie Davis
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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