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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313602542
Report Date: 07/26/2024
Date Signed: 07/28/2024 05:45:28 PM

Document Has Been Signed on 07/28/2024 05:45 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:STAR MAIDUFACILITY NUMBER:
313602542
ADMINISTRATOR/
DIRECTOR:		JODI BARKERFACILITY TYPE:
840
ADDRESS:1950 JOHNSON RANCH ROADTELEPHONE:
(916) 782-8454
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 300TOTAL ENROLLED CHILDREN: 300CENSUS: 111DATE:
07/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Jodi BarkerTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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Licensing Program Analysts (LPAs) Jeremey McClain met with facility representative Jodi Barker for an unannounced Case Management Inspection regarding an Unusual Incident Report.

111 school age children were present during the inspection supervised by 19 staff members.

It was reported that on 07/23/2024, a child in care fell while they were playing a game in the gymnasium. The child was treated at the hospital after they were picked up by their parents and was diagnosed with an acute concussion. During today’s inspection LPA conducted staff interviews and observed the gymnasium where the incident occurred. LPA concluded that the incident was not due to lack of supervision, and there were no visible hazards in the gymnasium.

An exit interview was conducted, and the report was reviewed with facility representative Jodi Barker. A Notice of Site Visit was provided and shall remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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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