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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617215
Report Date: 04/19/2022
Date Signed: 04/19/2022 01:30:10 PM

Document Has Been Signed on 04/19/2022 01:30 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:KELLI'S PALS PRESCHOOL & DAY CAREFACILITY NUMBER:
343617215
ADMINISTRATOR:BOYD, LINFACILITY TYPE:
850
ADDRESS:501 SAN JUAN ROADTELEPHONE:
(916) 922-0724
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 18DATE:
04/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lin BoydTIME COMPLETED:
01:45 PM
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On 04/19/22, Licensing Program Analyst (LPA) Jan Hoshida met with Owner Lin Boyd for a case management inspection on this date to discuss the unusual incident report (UIR) that the program submitted on 04/15/22. LPA observed 18 children with two staff present.

LPA conducted interviews and observed care and supervision of children in care.

No deficiencies were cited in today’s visit.

Exit interview and notice of site visit was posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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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