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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313625036
Report Date: 06/04/2024
Date Signed: 06/05/2024 07:05:29 AM

Document Has Been Signed on 06/05/2024 07:05 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:STAR GATEWAYFACILITY NUMBER:
313625036
ADMINISTRATOR/
DIRECTOR:		PETERS, RACHELFACILITY TYPE:
840
ADDRESS:6550 LONETREE BLVDTELEPHONE:
(916) 632-8407
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 300TOTAL ENROLLED CHILDREN: 300CENSUS: 28DATE:
06/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Sam RusselTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Jeremey McClain and Kyrsten Williams met with facility representative Sam Russel for an unannounced Case Management Inspection regarding an Unusual Incident Report.

LPAs observed 28 children supervised by five staff members.

It was reported that 05/15/24, a child reported an inappropriate interaction from another child while using the bathroom. The child’s parent followed up with further accusations from the child. A CPS report was also filed. A case management was done today to assess the possibility of lack of supervision and or a violation of personal rights. LPAs interviewed staff and observed bathroom procedures from staff. Further investigation will need to be conducted.

An exit interview was conducted, and the report was reviewed with facility representative Sam Russel. 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: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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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