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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622833
Report Date: 04/12/2024
Date Signed: 04/12/2024 12:51:12 PM

Document Has Been Signed on 04/12/2024 12:51 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/
DIRECTOR:		TAYLOR, CHAUNCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 904-9166
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
04/12/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Chauncy TaylorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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At 10:45am on 4/12/2024, Licensing Program Analysts (LPAs) Loraine Perez and Matthew Gallo met with licensee Chauncy Taylor for the purpose of a collateral visit in relation to a complaint regarding a separate licensed facility. Today's census included 5 preschool children supervised by licensee and another adult.

During today's visit, LPAs interviewed individuals relevant to the complaint regarding the separate licensed facility.

No deficiencies were observed during today's visit.

Exit interview conducted and report was reviewed with the licensee, Chauncy Taylor. A notice of site visit was given and must remain posted for 30 days. Appeal rights provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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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