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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573619923
Report Date: 10/10/2023
Date Signed: 10/10/2023 11:15:35 AM


Document Has Been Signed on 10/10/2023 11:15 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:PEREGRINE SCHOOLFACILITY NUMBER:
573619923
ADMINISTRATOR:GABRIELA CORTEZFACILITY TYPE:
850
ADDRESS:2650 LILLARD DRIVETELEPHONE:
(530) 753-5500
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY:90CENSUS: 64DATE:
10/10/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:director, Gabriela CortezTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Lauren Scott met with Director, Gabriela Cortez for the purpose of an unannounced plan of correction inspection to clear three Type B deficiencies, which was issued on 9/8/23 for conducting fire drills, signing children in/ out and medication storage.

During today's inspection LPAs toured all areas accessible to children in care. LPA observed proper fire drill documentation, sign in and outs and medication storage.

Deficiencies cited on 9/8/23 is cleared effective today. Exit interview conducted and report was reviewed with the licensee. 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.
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Lauren ScottTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023
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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