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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340306383
Report Date: 10/30/2024
Date Signed: 10/30/2024 11:20:27 AM

Document Has Been Signed on 10/30/2024 11:20 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:MARVIN MARSHALL CHILDREN'S CENTERFACILITY NUMBER:
340306383
ADMINISTRATOR/
DIRECTOR:		VONG,JACK,MANI, REYNOLDSFACILITY TYPE:
850
ADDRESS:5309 KENNETH AVENUETELEPHONE:
(916) 971-7380
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 209TOTAL ENROLLED CHILDREN: 209CENSUS: 11DATE:
10/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Angelica DennisTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On October 30, 2024, Licensing Program Analyst (LPA) Josiah Gathing met with Angelica Dennis TOSA for Infant Toddler for the purpose of a Case Management inspection and to follow up on an Unusual Incident reported to Licensing on October 21, 2024. LPA conducted in-person and telephone interviews during the inspection.

No deficiencies were cited during today's inspection. LPA conducted an exit interview and provided a printed copy of this report to TOSA. A Notice of Site Visit was also provided and shall remain posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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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