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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500423
Report Date: 04/10/2023
Date Signed: 04/10/2023 05:21:16 PM

Document Has Been Signed on 04/10/2023 05:21 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:TINY TOTS ACADEMYFACILITY NUMBER:
394500423
ADMINISTRATOR:CANDI KETTGENFACILITY TYPE:
840
ADDRESS:250 NORTHGATE DRIVETELEPHONE:
(209) 294-9803
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 6DATE:
04/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:50 PM
MET WITH:Renae ShowmanTIME COMPLETED:
05:30 PM
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 Licensing Program Analyst (LPA) Corina Beckby and Licensing Program Manager (LPM) Bettina Engelman conducted an unannounced Case Management inspection to verify the removal of an excluded individual, Elizabeth J Solomon.

LPA & LPM inspected the entire facility inside and out . Director understands this person is not permitted to be in the facility or on the premises at any time when children are in care.

Based on evidence obtained during today's inspection, LPA and LPM verified the individual is not present or employed.

Director signed LIC300B Confirmation of Removal for Elizabeth J Solomon.

No deficiencies were cited today under Title 22 Division 12 of the Ca. Code of Regulations.

This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Notice of sit visit was observed being posted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2023
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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