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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573604201
Report Date: 03/28/2024
Date Signed: 03/28/2024 11:48:43 AM

Document Has Been Signed on 03/28/2024 11:48 AM - 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LA RUE PARK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
573604201
ADMINISTRATOR:SHELBY FARIAFACILITY TYPE:
850
ADDRESS:50 ATRIUM WAYTELEPHONE:
(530) 753-8716
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 38DATE:
03/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Shephanie LunaTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Jennie Tedlos conducted a case management inspection to deliver an Immediate Exclusion Order. The employee being served is Shah Naveed. LPA observed 38 children supervised by 8 staff. Criminal record clearances have been verified.

Licensing staff did not observe Ms. Naveed to be present at the facility today. Facility Representative, Stephanie Luna, stated that this facility, License #573604201, has never had an employee or volunteer named Shah Naveed. Shah Naveed was associated to the facility's roster due to the waiver on file. License #573604201 is the central administrative file for criminal record association purposes for multiple facilities, however Ms. Naveed was never directly employed by this facility. This waiver is on file and displayed at the facility.

Today, the Facility Representative, Stephanie Luna, was advised and understands that the individual listed above cannot be present at this facility.

An exit interview was conducted with the Facility Representative.

LPA reviewed report with the Facility Representative, Stephanie Luna, and provided copies of the report along with Appeal Rights. A notice of site visit was provided and posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


No Title 22 Deficiencies were cited during the visit.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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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