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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620767
Report Date: 06/08/2022
Date Signed: 06/08/2022 10:50:37 AM

Document Has Been Signed on 06/08/2022 10:50 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CAMELLIA WALDORF SCHOOLFACILITY NUMBER:
343620767
ADMINISTRATOR:BAGLEY, SUSANFACILITY TYPE:
850
ADDRESS:7450 POCKET ROADTELEPHONE:
(916) 427-5022
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 12DATE:
06/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shannon Leigh TIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 9:00am and met with Shannon Leigh, director, regarding an Unusual Incident that took place May 16, 2022. LPA made observations, interviewed staff and gathered documents pertaining to the investigation.

Director stated that whenever they enter the area, they walk the perimeter to see if there is anything unusual and that they try to teach the children to ask before they touch anything.

No Title 22 Deficiencies observed in the areas that were evaluated. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2022
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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