Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610864
Report Date: 04/23/2015 12:00:00 AM
Date Signed 04/23/2015 02:10:45 PM

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:FAMILY MATTERS EARLY LEARNING CENTER/ PRESCHOOLFACILITY NUMBER:
343610864
ADMINISTRATOR:NELSON, GINAFACILITY TYPE:
850
ADDRESS:5452 14TH AVETELEPHONE:
(916) 457-4067
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:42CENSUS: 20DATE:
04/23/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Gina NelsonTIME COMPLETED:
02:35 PM
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(1) Licensing Program Analyst, Nancy Kyotani met with owner/director, Gina Nelson for an Annual Random visit. LPA toured the buildings including all activity/classroom areas, food service area, restrooms and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, including medications, furniture, equipment, drinking water and food service provisions.

LPA reviewed the sign/in-sign/out sheet, and at least one staff member present today has current Pediatric CPR and First Aid. All staff currently employed with the facility have criminal record clearances, poisons are locked, and there are no firearms or bodies of water on the property. LPA reviewed children's medical assessment (Physician Report), Identification and Emergency information and staff's LIC503 Health Screening.

LPA reviewed Departments inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in director's absence must be reported to department within 10 working days.

There were no Title 22 Deficiencies cited during this visit.

Exit interview was conducted with the owner/director.

Notice of Site Visit was posted prior to LPA leaving the facility.
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Nancy KyotaniTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2015
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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