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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313621978
Report Date: 07/05/2022
Date Signed: 07/05/2022 12:37:10 PM


Document Has Been Signed on 07/05/2022 12:37 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:STAR CARLIN C. COPPINFACILITY NUMBER:
313621978
ADMINISTRATOR:VANDENHOFF, KRISTINEFACILITY TYPE:
840
ADDRESS:150 E. 12TH STREETTELEPHONE:
(916) 632-8407
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:60CENSUS: 0DATE:
07/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Michelle Brashier and Ashley WeatherlyTIME COMPLETED:
01:00 PM
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LPA Amanda Blesi met with Regional Administrator Michelle Brashier and teacher Ashley Weatherly for a case management inspection. Facility has requested to move their program from room C and E to room K.

LPA toured portable K for a health and safety evaluation. LPA observed a carbon monoxide detector and cubbies for the children's belongings. Water is provided via pitchers are individual cups.

Per today's inspection, rooms K on the Carlin C Coppin Elementary School is cleared for use by the STAR program once an approved fire clearance is received.

No deficiencies cited today.
Exit interview with Michelle Brashier and Ashley Weatherly.
Notice of Site Visit provided.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
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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