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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093616106
Report Date: 08/08/2019
Date Signed: 08/08/2019 02:26:51 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:ADVENTURE BEGINS, THEFACILITY NUMBER:
093616106
ADMINISTRATOR:OCAMPO, JAIMEFACILITY TYPE:
850
ADDRESS:3841 PONDEROSA ROADTELEPHONE:
(530) 676-4415
CITY:SHINGLE SPRINGSSTATE: CAZIP CODE:
95682
CAPACITY:35CENSUS: 22DATE:
08/08/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Nadine Bentovoja-JeffordTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA), Jan Hoshida, met with Assistant Director, Nadine Bentovoja-Jefford, for a case management visit on this date to discuss the unusual incident report (UIR) that the program submitted and which occurred on 7/24/2019. Upon arrival, LPA observed 22 children with three staff present.

LPA conducted interviews, observed care and supervision of children in care, reviewed files and obtained necessary documents.

No deficiencies were cited in today’s visit.

Exit interview and notice of site visit was posted.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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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