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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393607795
Report Date: 03/22/2023
Date Signed: 03/22/2023 01:32:59 PM

Document Has Been Signed on 03/22/2023 01:32 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:MERLO PRESCHOOLFACILITY NUMBER:
393607795
ADMINISTRATOR:SOUPHONE LAEMFACILITY TYPE:
850
ADDRESS:1670 EAST SIXTH STREETTELEPHONE:
(209) 933-7190
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
03/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Lead PM Teacher Souphone LaemTIME COMPLETED:
01:45 PM
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On 3/22/23 Licensing Program Analyst (LPA) Carla Polanco met with Lead PM Teacher Souphone Laem for the purpose of amending an 809 report that was originally created on 3/8/23. During today's visit there were 13 children being supervised by 5 adults.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2023
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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