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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317948
Report Date: 03/08/2024
Date Signed: 03/08/2024 12:49:01 PM

Document Has Been Signed on 03/08/2024 12:49 PM - 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:ETHEL PHILLIPS PRESCHOOLFACILITY NUMBER:
340317948
ADMINISTRATOR:PALMER/POWELLFACILITY TYPE:
850
ADDRESS:2930 21ST AVENUETELEPHONE:
(916) 277-6252
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 50TOTAL ENROLLED CHILDREN: 22CENSUS: 0DATE:
03/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Holly DaniyelyanTIME COMPLETED:
01:15 PM
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On Friday, March 8 2024 at 12:25 PM, Licensing Program Analyst (LPA) Tanya Washington met with Facility Representative Holly Daniyelyan for a case management inspection regarding a self reported unusual incident which occurred on 02/23/2024. There were no children in care upon arrival as Fridays are early release days and children leave by 12:15 PM.

During today's inspection, LPA toured the playground and classroom area and conducted staff interviews.

No deficiencies are cited during today's inspection. Notice of site visit posted and appeal rights are provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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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