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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343605736
Report Date: 12/19/2023
Date Signed: 12/19/2023 10:13:43 AM

Document Has Been Signed on 12/19/2023 10:13 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:COTTAGE STATE PRESCHOOLFACILITY NUMBER:
343605736
ADMINISTRATOR:ROBINSON, KIMFACILITY TYPE:
850
ADDRESS:2221 MORSE AVENUETELEPHONE:
(916) 575-2306
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 20DATE:
12/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kim RobinsonTIME COMPLETED:
10:30 AM
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On December 19, 2023, at approximately 9:30 AM, Licensing Program Analyst (LPA) Josiah Gathing met with Director Kim Robinson for the purpose of a Case Management inspection to follow up with a self-reported unusual incident. During today's inspection, there were 20 preschool children being supervised by two staff and the Director. LPA made observations, collected documentation, and interviewed the facility Director.

No deficiencies were cited during today's inspection. LPA conducted an exit interview and provided a printed copy of this report to the Director. 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: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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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