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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
340304992
Report Date:
03/20/2024
Date Signed:
03/20/2024 09:37:09 AM
Document Has Been Signed on
03/20/2024 09:37 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 CC RO
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
CENTENNIAL CHRISTIAN PRE-SCHOOL
FACILITY NUMBER:
340304992
ADMINISTRATOR:
OTTO, BRIEANNE
FACILITY TYPE:
850
ADDRESS:
5401 FREEPORT BLVD.
TELEPHONE:
(916) 453-0976
CITY:
SACRAMENTO
STATE:
CA
ZIP CODE:
95822
CAPACITY:
35
TOTAL ENROLLED CHILDREN:
35
CENSUS:
22
DATE:
03/20/2024
TYPE OF VISIT:
Case Management - Licensee Initiated
UNANNOUNCED
TIME BEGAN:
08:45 AM
MET WITH:
Brieanne Otto
TIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 8:45am and met with director Brieanne Otta for an unannounced Case Management Licensee Initiated inspection. Today’s inspection regarded a room for daycare use. Fire clearance was granted on 3/19/2024. LPA observed that the room at time of inspection was in compliance with Title 22 regulations and the Health and Safety Code. LPA approves room for use effective 3/20/2024.
No Title 22 Deficiencies
observed in the areas that were evaluated. LPA reviewed report with the director and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the director understands it must remain posted for 30 days.
SUPERVISORS NAME
:
Amanda Blesi
LICENSING EVALUATOR NAME
:
Christopher Bello
LICENSING EVALUATOR SIGNATURE
:
DATE:
03/20/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/20/2024
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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