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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500417
Report Date: 04/13/2023
Date Signed: 04/13/2023 11:23:26 AM

Document Has Been Signed on 04/13/2023 11:23 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: 16TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Ivy StinsonTIME COMPLETED:
11:45 AM
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On 04/13/23 Licensing Program Analyst (LPA) Elvira Sierra conducted an unannounced Case Management inspection to verify removal of an excluded individual (Elizabeth Solomon). LPA informed Director, Ivy Stinson of the reason for the inspection. Director stated that individual stopped working at the facility before she got hired back in May 2022.

LPA toured the day care facility inside and outside and observed that there were no children present in the kindergarten classroom. Director stated that children will start arriving at 12:30pm.

Based on evidence obtained during today's inspection, the LPA has verified the individual is not present, employed or residing at the facility.

LPA has advised facility representative to disassociate the individual from their roster.

Verification of Removal is complete.

Exit interview was conducted and this report and Appeal of Rights were reviewed and provided to facility representative, Ivy Stinson. Notice of Site Visit was posted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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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