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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573614773
Report Date: 12/15/2022
Date Signed: 10/04/2023 04:45:22 PM

Document Has Been Signed on 10/04/2023 04:45 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:PINCILOTTI, LILYFACILITY NUMBER:
573614773
ADMINISTRATOR:PINCILOTTI, LILYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 220-3499
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
12/15/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:licensee, Lily PincilottiTIME COMPLETED:
01:00 PM
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On 12/15/22 LPA Lauren Scott conducted an unannouced annual inspection for licensee, Lily Pincilotti. LPA final printed the visit with incorrect time began and time complete notes. LPA noted the visit from 11:30am-12:00pm. Actual time of inspection was 11:30am-1:00pm. LPA put the additional time (12:00-1:00pm) on this collateral visit.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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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