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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622833
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:39:45 PM

Document Has Been Signed on 02/27/2024 02:39 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:TAYLOR, CHAUNCYFACILITY NUMBER:
343622833
ADMINISTRATOR:TAYLOR, CHAUNCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 904-9166
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 14TOTAL ENROLLED CHILDREN: 24CENSUS: 3DATE:
02/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Chauncy TaylorTIME COMPLETED:
03:00 PM
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On February 27, 2024 at 1:50 PM, Licensing Program Analysts (LPAs) Tanya Washington and Loraine Perez met with Licensee, Chauncy Taylor for an unannounced case management inspection regarding a self reported incident which the Licensee reported on 02/16/2024. Upon arrival LPAs observed care and supervision of three daycare children supervised by the Licensee. Licensing staff conducted an interview with the Licensee and reviewed records.

Based on today's inspection, no Title 22 Regulation violations are cited.

Notice of site visit posted. Appeal rights are provided.


SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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