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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700007
Report Date: 12/10/2021
Date Signed: 12/10/2021 12:13:04 PM

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.270
SACRAMENTO, CA 95833
FACILITY NAME:MARCONI VILLAFACILITY NUMBER:
342700007
ADMINISTRATOR:STROUP, JAMES & JENNIFERFACILITY TYPE:
740
ADDRESS:2100 MARCONI AVENUETELEPHONE:
(916) 571-5270
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 4DATE:
12/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jennifer Stroup and Dalee DahleyTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Avelina Martinez conducted a case management visit to the facility
on today's date for the purpose of delivering an Order to Individual of Immediate Exclusion from all facilities
and the Order to Licensee/Facility of Immediate Exclusion From Facility.

LPA Martinez met with staff Dalee Dahley, and explained the purpose of today's visit. LPA Martinez also conducted a phone call with Licensee, Jennifer Stroup, during the visit. LPA Martinez explained the purpose of the phone call and today's visit. Moreover, LPA Martinez informed Dalee Dahley and Jennifer Stroup that Staff Kamethia Edwards is excluded from all licensed facilities.

Per Jennifer Stroup, an employee transfer request was submitted to SACASCTransferRequest@dss.ca.gov for Kamethia Edwards on December 8, 2021. In addition, Kamethia Edwards was not scheduled to work at this facility. Per Jennifer Struop, Kamethia Edwards was not scheduled to work at this facility due to the pending employee transfer request, which was completed on December 10, 2021. LPA Martinez provided the Dalee Dahley with the Order to Licensee/Facility of Immediate Exclusion From Facility letter and explained that Kamethia Edwards is not allowed in facility effective immediately.

An exit interview was conducted, a copy of this report and Immediate Exclusion letter was provided to Dalee Dahley.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
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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