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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500401
Report Date: 10/28/2021
Date Signed: 10/28/2021 12:50:15 PM

Document Has Been Signed on 10/28/2021 12:50 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:DJUSD EARLY LEARNING CENTER AT KOREMATSUFACILITY NUMBER:
574500401
ADMINISTRATOR:JENNA GONZALEZFACILITY TYPE:
850
ADDRESS:3100 LOYOLA DRIVETELEPHONE:
(530) 757-5340
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 11DATE:
10/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Program Director, Tereadel Sosa-BorgesTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Chayntel Hunter met with Program Director, Tereadel Sosa-Borges to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 10/07/2021. During today's visit the facility was toured. Present were 11 preschool children in care and 4 staff.

LPA interviewed the Program Director and staff who was present during the incident. The facility reported the UIR to Community Care Licensing within 24hrs. A written UIR was submitted within 7 days, describing the specifics of the incident.

Facility evaluation report was reviewed and discussed with Program Director. Exit interview was conducted. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
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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