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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603677
Report Date: 05/10/2023
Date Signed: 06/27/2023 12:41:07 PM

Document Has Been Signed on 06/27/2023 12:41 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:COTTAGE KIDS CHILDREN'S CENTERFACILITY NUMBER:
343603677
ADMINISTRATOR:ALLEY, NICOLEFACILITY TYPE:
850
ADDRESS:2800 COTTAGE WAYTELEPHONE:
(916) 979-2011
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 49DATE:
05/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Nicole AlleyTIME COMPLETED:
03:25 PM
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On June 27, 2023 at approximately 12:00 PM Licensing Program Analyst Josiah Gathing met with Director Nicole Alley for the purpose of an unannounced Case Management investigation. The purpose of this inspection was to amend a previous report which documented an investigation into an incident report submitted to the Licensing program on June 1, 2023. During the investigation LPA conducted interviews and made observations.

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Director. This report and appeal rights were printed and provided to the Director. No deficiencies were cited during today's investigation.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2023
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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