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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393617338
Report Date: 06/28/2023
Date Signed: 06/28/2023 02:34:39 PM


Document Has Been Signed on 06/28/2023 02:34 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:MY CURIOUS MONKEY'S CHILDCAREFACILITY NUMBER:
393617338
ADMINISTRATOR:SOUZA, SHANNONFACILITY TYPE:
850
ADDRESS:125 BERVERDOR AVENUETELEPHONE:
(209) 832-5437
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:35CENSUS: 13DATE:
06/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Shannon Souza TIME COMPLETED:
02:28 PM
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On June 28, 2023 , Licensing Program Analyst (LPA) Stacey Williams met with Director, Shannon Souza for the purpose of conducting a case management inspection. LPA observed (13) thirteen children supervised by three staff.

LPA and Director discussed Lead Testing for the facility.

LPA reviewed report with the Director, Shannon Souza and provided copies of the report along with Appeal Rights. A notice of site visit was provided and posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023
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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