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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500417
Report Date: 08/25/2022
Date Signed: 08/25/2022 11:28:31 AM

Document Has Been Signed on 08/25/2022 11:28 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:ACHIEVERSFACILITY NUMBER:
394500417
ADMINISTRATOR:STINSON, IVYFACILITY TYPE:
840
ADDRESS:4453 PRECISSI LANETELEPHONE:
(209) 956-5437
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/25/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ivy StinsonTIME COMPLETED:
11:00 AM
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Application Specialist (AS) Alecia Sifuentes met with Director, Ivy Stinson for the purpose of an announced change of capacity case management inspection. Licensee requests to serve 16 school-age children enrolled in kindergarten and above. The program operates Monday through Friday from 7:00 a.m. to 6:00 p.m. The fire clearance was granted and received on 8/22/2022.

INDOOR ACTIVITY SPACE:
There is one school-age multipurpose room (Great Room). AS used current indoor measurements. The total multipurpose room space contains a total of 1,055 square feet, which will accommodate Licensee's request for 16 school-age children. There are 2 toilets and 2 sinks for the children, and a separate private restroom for the staff.

OUTDOOR ACTIVITY SPACE:
There is one school-age outdoor area. AS used current outdoor measurements. The school-age outdoor area contains a total of 1,265 square feet, which will accommodate Licensee’s request for 16 school-age children.

Licensee was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Report continues LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: ACHIEVERS
FACILITY NUMBER: 394500417
VISIT DATE: 08/25/2022
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Exit interview conducted and report was reviewed with the Director, Ivy Stinson. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Effective today, 8/25/2022, AS will approve the change of capacity for 16 school-age children.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC809 (FAS) - (06/04)
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