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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 050320948
Report Date: 01/23/2020
Date Signed: 01/23/2020 12:01:40 PM

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,SAN ANDREAFACILITY NUMBER:
050320948
ADMINISTRATOR:RUTH HICKSFACILITY TYPE:
850
ADDRESS:501 GOLD STRIKE RDTELEPHONE:
(209) 754-1600
CITY:SAN ANDREASSTATE: CAZIP CODE:
95249
CAPACITY:49CENSUS: 16DATE:
01/23/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Ruth HicksTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Justin Denton conducted an unannounced case management inspection regarding a report received on 1/21/20.

Upon arrival, LPA determined that the report received actually referred to the infant center across the street (#053604859). LPA confirmed this information at the infant facility and returned to the preschool facility to provide documentation of a licensing visit.

No deficiencies were cited at this time.

A copy of this report was left with the facility.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
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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