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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621064
Report Date: 01/28/2022
Date Signed: 01/28/2022 02:33:29 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:CAMPUS DOWNTOWN, INC., THEFACILITY NUMBER:
393621064
ADMINISTRATOR:ELIZABETH A HERRERAFACILITY TYPE:
850
ADDRESS:123 NORTH SUTTER STTELEPHONE:
(209) 594-1879
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY:96CENSUS: 32DATE:
01/28/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Elizabeth A HerreraTIME COMPLETED:
03:00 PM
NARRATIVE
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On Friday, January 28, 2022, Licensing Program Analyst (LPA) Elvira Sierra met with Director, Elizabeth A. Herrera for a case management inspection as a result of receiving an unusual incident report. On 01/21/22 an incident occurred, when a child wandered away from the facility through a gate located in the playground. Child was found nearby a parking garage. Immediately following the incident, a new protocol was implemented, ensuring that all the doors remain closed and are in good repair. Per Director, training staff on topics of transition and supervision are ongoing. LPA observed adequate levels of supervision today.

The attached type A deficiency is cited in the next page. Upon receipt, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted. Appeal rights were given and discussed. A site visit notice was posted and must remain posted for 30 days.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CAMPUS DOWNTOWN, INC., THE
FACILITY NUMBER: 393621064
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/31/2022
Section Cited

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1596.99(c)(3) (c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues ....:(3) Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age.
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This requirements was not met as evidence by; Facility self reported an incident ocurred on 01/21/22 that a child wandered away from the facility's grounds close to a nearby parking garage. This is a violation thta if not corrected can pose an immediate risk to the children in care.
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Facility will conduct another meeting on February 14, 2022, to discuss additional supervision issues. Deficiency is cleared on today's visit. Civil Penalty of five hunded follars($500.00) will be assess on the next page.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2022
LIC809 (FAS) - (06/04)
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