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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623207
Report Date: 11/10/2021
Date Signed: 11/10/2021 09:13:59 AM

Document Has Been Signed on 11/10/2021 09:13 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:NOLAND, NICOLETTEFACILITY NUMBER:
343623207
ADMINISTRATOR:NOLAND, NICOLETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 292-8000
CITY:SACRAMENTOSTATE: CAZIP CODE:
95816
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
11/10/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Nicolette NolandTIME COMPLETED:
09:30 AM
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LPAs Amanda Blesi and Katrina Owens arrived unannounced to conduct a case management inspection to clear the deficiency cited on 11/03/2021. Present upon arrival were six day care children, licensee, Nicolette and two assistants. A tour of the facility was conducted. The deficiency cited for licensee not being present in the facility is cleared per today's inspection.

A letter of clearance was provided to licensee.

Exit interview with Nicolette.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2021
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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