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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 550308991
Report Date: 10/29/2024
Date Signed: 10/29/2024 01:32:58 PM

Document Has Been Signed on 10/29/2024 01:32 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:SOULSBYVILLE PM CLUBFACILITY NUMBER:
550308991
ADMINISTRATOR/
DIRECTOR:		JULIE DUARTEFACILITY TYPE:
840
ADDRESS:20300 SOULSBYVILLE ROADTELEPHONE:
(209) 768-3562
CITY:SOULBYVILLESTATE: CAZIP CODE:
95372
CAPACITY: 100TOTAL ENROLLED CHILDREN: 53CENSUS: 0DATE:
10/29/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Director, Julie DuarteTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Tobias Lake met with Director, Julie Duarte, for the purpose of a room addition case management inspection. Licensee is requesting an additional classroom, 54, now be used as a School Age Program room. Fire Clearance is on file, submitted by Soulsbyville School District. As of 10/29/2024, clearance is granted to use the additional classroom.

Licensee was reminded that all adults 18 and over, 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.

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.

Exit interview conducted and report was reviewed with the director, Julie Duarte.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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