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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625368
Report Date: 08/20/2024
Date Signed: 08/20/2024 02:54:56 PM

Document Has Been Signed on 08/20/2024 02:54 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:SCUSD - CLAYTON B. WIRE PRESCHOOLFACILITY NUMBER:
343625368
ADMINISTRATOR/
DIRECTOR:		THERESA PEREZFACILITY TYPE:
850
ADDRESS:5100 EL PARAISO AVENUETELEPHONE:
(916) 643-7814
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
08/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Aida BuelnaTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Arianna Manabat met with the Consultant Aida Buelna for the purpose of an announced case management inspection. The purpose of today's visit is to follow-up on the pending items for licensure. During the previous visit it was determined that the facility needed to fix the following items:
1. A functioning carbon monoxide detector
2. Proof of a fence that meets regulations
3. Proof of leveling the outdoor area or ensuring the tripping hazards have been addressed.

During today's visit, LPA Manabat observed and documented that the facility addressed the pending items for licensure. An exit interview conducted and report was reviewed with the Licensee Representative Aida Buelna.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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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