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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622008
Report Date: 10/31/2022
Date Signed: 10/31/2022 12:07:15 PM

Document Has Been Signed on 10/31/2022 12:07 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ICONIC KIDS CHILDCARE & LEARNING CENTERFACILITY NUMBER:
343622008
ADMINISTRATOR:THOMPSON, IONAFACILITY TYPE:
850
ADDRESS:6035 MAIN AVENUETELEPHONE:
(916) 542-7196
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 47TOTAL ENROLLED CHILDREN: 47CENSUS: 6DATE:
10/31/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Iona Thompson TIME COMPLETED:
12:15 PM
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Licensing Program Analyst Jennifer Velasco (LPA) conducted a Case Management visit to follow up on an Unusual Incident Report (UIR). LPA met with Director Iona Thompson (D1). During the visit, LPA toured the facility inside and outside, reviewed facility documents, and conducted interviews.

Based on document review and witness statements, the facility operated within regulatory requirements. No deficiency was cited during today's visit. This report was reviewed with D1, and an exit interview was conducted. A Notice of Site Visit (NOS) was provided to D1, who will post it where visible to parents for no less than 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2022
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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