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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621219
Report Date: 09/20/2023
Date Signed: 09/20/2023 10:18:04 AM

Document Has Been Signed on 09/20/2023 10:18 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:KING'S CHILDREN'S ACADEMYFACILITY NUMBER:
343621219
ADMINISTRATOR:KING, JOSETTEFACILITY TYPE:
850
ADDRESS:2635 EDISON AVENUETELEPHONE:
(916) 993-6510
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 49TOTAL ENROLLED CHILDREN: 49CENSUS: 10DATE:
09/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Josette KingTIME COMPLETED:
10:35 AM
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On September 20, 2023, Licensing Program Analysts (LPAs) Kyrsten Williams and Amanda Sutter met with Director Josette King for a case management inspection to discuss the unusual incident report (UIR) that was reported and submitted on August 8, 2023. Upon arrival, LPAs observed 10 children supervised by one staff.
LPAs made observations and conducted an interview.

No deficiencies were cited in today’s visit.

Exit interview was conducted with Josette King and notice of site visit was posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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