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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500782
Report Date: 02/28/2024
Date Signed: 02/28/2024 10:00:48 AM

Document Has Been Signed on 02/28/2024 10:00 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PEREGRINE SCHOOLFACILITY NUMBER:
574500782
ADMINISTRATOR:CORTEZ, GABRIELAFACILITY TYPE:
830
ADDRESS:2650 LILLARD DRIVETELEPHONE:
(530) 753-5500
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 6DATE:
02/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director, TIME COMPLETED:
10:00 AM
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Licensing Program Analysts (LPAs) Lauren Scott and Janie Davis met with Director, Gabriela Cortez to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 02/16/2024.

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.

LPAs toured the facility and interviewed staff. LPAs reviewed and discussed this report with the director.

Through interviews, it was revealed opening procedures didn't include a sweep of the outside area. Facility stated they are now cleaning the outside area prior to children coming outside and have purchased a leaf blower to help ensure cleanliness.

Facility evaluation report was reviewed and discussed with director. Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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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