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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500375
Report Date: 05/09/2024
Date Signed: 05/09/2024 03:20:51 PM

Document Has Been Signed on 05/09/2024 03:20 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CAPC - MAINFACILITY NUMBER:
394500375
ADMINISTRATOR/
DIRECTOR:		NORIEGA, BLANCAFACILITY TYPE:
850
ADDRESS:800 E MAIN STTELEPHONE:
(209) 851-3479
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY: 34TOTAL ENROLLED CHILDREN: 25CENSUS: 19DATE:
05/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Kim BallardTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 05/09/24, Licensing Program Analyst (LPA) Elvira Sierra met with ECE Director, Kim Ballard for an unannounced Case Management inspection. ECE Program Director, Angie Lopez arrived later during the inspection. Present in the facility were 5 staff caring for 19 children during today inspection.

The purpose of the inspection was explained and was to discuss an unusual incident that occurred on 05/02/24; which was self-reported to the department by the facility. During today’s inspection, LPA observed the care and supervision of children, conducted interviews with staff, and reviewed pertaining documents. Due to insufficient information available at this time, incident needs further investigation.

An exit Interview was conducted in which the report was reviewed and discussed with Facility representatives, Kim Ballard and Angie Lopez. A copy of the report was provided and a notice of site visit was posted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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