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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620521
Report Date: 05/31/2023
Date Signed: 06/08/2023 06:20:36 AM


Document Has Been Signed on 06/08/2023 06:20 AM - 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:MICHIGAN EARLY CARE & LEARNING CENTERFACILITY NUMBER:
393620521
ADMINISTRATOR:SAVINA GAINESFACILITY TYPE:
850
ADDRESS:3156 MICHIGAN AVENUETELEPHONE:
(209) 941-9100
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:38CENSUS: 0DATE:
05/31/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cecilia WarrenTIME COMPLETED:
12:00 PM
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On May 31st, 2023, at 11:00 AM, Licensing Program Analyst (LPA), David Nguyen and Licensing Program Manager (LPM) Chayntel Hunter met with Executive Director Cecilia Warren and Director of Monitoring and Compliance, Maudie Dashiell at Sacramento South Regional Office to follow up on the two (2) Unusual Incident Reports (UIR) submitted to the Community Care Licensing, Division (CCLD) on May 3rd, 2023 and May 15th, 2023.

LPA and LPM discussed the two (2) UIRs with the Executive Director and Director of Monitoring and Compliance.



Facility evaluation report was reviewed and discussed with Executive Director. Exit interview was conducted.

In the areas that were evaluated/discussed, no deficiencies were cited during today's meeting.
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023
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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