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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624175
Report Date: 03/09/2023
Date Signed: 03/09/2023 03:03:10 PM

Document Has Been Signed on 03/09/2023 03:03 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:TATOM, TENISHAFACILITY NUMBER:
343624175
ADMINISTRATOR:TATOM, TENISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 384-7263
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
03/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Tenisha TatomTIME COMPLETED:
02:15 PM
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LPA Pascual met with Licensee Tenisha Tatom at approximately 1:15PM, for the purpose of clearing a ratio deficiency and ensuring the assistant was present. Upon observation there were three children in care, two of which, were infants with both the licensee and assistant present.

No other concerns or issues were observed and the proof of correction was cleared.

An exit interview was conducted and a Notice of Site visit was provided and shall be posted for 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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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