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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622079
Report Date: 02/27/2020
Date Signed: 02/27/2020 03:03:14 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:PERDUE, KRISTIFACILITY NUMBER:
393622079
ADMINISTRATOR:PERDUE, KRISTIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 740-0165
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:14CENSUS: 13DATE:
02/27/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Kristi PerdueTIME COMPLETED:
03:15 PM
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On February 27,2020 Licensing Program Analyst (LPA) Stacey Williams met with Licensee, Kristi Perdue for a Plan of Correction inspection. Licensee's Assistant was present during today's inspection. LPA toured the childcare room with Licensee and observed (13) thirteen children supervised by Licensee and her Assistant. At 2:10 PM , LPA discussed the deficiency cited on February 20, 2020 with Licensee. Licensee showed LPA the revised capacity worksheet used to track daily capacity for the childcare. Licensee emailed LPA a copy of the tool during the inspection.

The Plan of Correction is cleared on today's date for the Type A deficiency cited on February 20, 2020.

An exit interview was conducted, and the licensing report was reviewed with Licensee, Kristi Perdue. A copy of this report and appeal rights were discussed and left with Licensee whose signature on this form confirm receipt of these documents. Notice of Site Visit was provided to post during today’s inspection.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
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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