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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 050309935
Report Date: 09/05/2019
Date Signed: 09/05/2019 11:03:06 AM

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:RESOURCE CONNECTION OF AMADOR&CALAVERAS,VLY SPGSFACILITY NUMBER:
050309935
ADMINISTRATOR:BIGGAM, LISAFACILITY TYPE:
850
ADDRESS:240 PINE ST.(V.S.ELEM SCHOOL)TELEPHONE:
(209) 754-3114
CITY:VALLEY SPRINGSSTATE: CAZIP CODE:
95252
CAPACITY:25CENSUS: 8DATE:
09/05/2019
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lisa BiggamTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Justin Denton conducted a collateral inspection at the facility and met with Site Supervisor, Lisa Biggam.

The purpose of the inspection was to interview Child 1 (C1) about an incident at another licensed facility.

No Title 22 deficiencies were cited during today's inspection. Exit interview conducted, and Notice of Site Visit posted.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
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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