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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 553602594
Report Date: 11/04/2019
Date Signed: 11/04/2019 11:26:57 AM

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:COLUMBIA COLLEGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
553602594
ADMINISTRATOR:TIFFANY FLIESFACILITY TYPE:
850
ADDRESS:11600 COLUMBIA COLLEGE DR.TELEPHONE:
(209) 588-5277
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:71CENSUS: 37DATE:
11/04/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kelly ThomasTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Justin Denton performed an unannounced case management inspection at the facility and met with Director Kelly Thomas. The purpose of the inspection was to interview Staff 1 (S1) about an incident reported to CCL on 6/10/19 that occurred at another child care center. S1 was present and LPA was able to conduct the interview.

There were no Title 22 deficiencies cited at this time. Notice of Site Visit posted and exit interview conducted.

A copy of this report was left with the facility.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2019
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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