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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500454
Report Date: 04/01/2022
Date Signed: 04/01/2022 12:38:58 PM

Document Has Been Signed on 04/01/2022 12:38 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
344500454
ADMINISTRATOR:BECKSTROM, MICHELEFACILITY TYPE:
850
ADDRESS:8610 SHELDON ROADTELEPHONE:
(916) 684-4222
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 168TOTAL ENROLLED CHILDREN: 168CENSUS: 66DATE:
04/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Michelle BeckstromTIME COMPLETED:
01:00 PM
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On 04/01/2022, Licensing Program Analyst (LPA) Katy Maestas conducted a tour of the facility. Upon inspection, it was noted that an individual was working in the capacity of a teacher and was not associated with the license. The individual is an employee of Child Time and has cleared fingerprints in Guardian. A Technical Violation was assessed.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2022
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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