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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615541
Report Date: 11/01/2023
Date Signed: 11/01/2023 01:02:42 PM


Document Has Been Signed on 11/01/2023 01:02 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:DEERING, STEFANIEFACILITY NUMBER:
573615541
ADMINISTRATOR:DEERING, STEFANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 996-0863
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:14CENSUS: 10DATE:
11/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Stefanie Deering TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Erwin Tjhia met with licensee, Stefannie Deering for an unannounced Case Management inspection. Present in the facility were 2 staff caring for 10 children during todays inspection.

The purpose of the inspection was explained and was to discuss an unusual incident that occurred on 10/25/23; which was self reported to the Department by the facility. During today’s inspection, LPA observed the care and supervision of children, conducted interviews with staff, and reviewed pertaining documents. Due to insufficient information available at this time, incident needs further investigation.

An exit Interview was conducted in which the report was reviewed and discussed with licensee, Stefannie Deering. A copy of the report was provided to Licensee and a Notice of Site Visit was posted by the LPA.

In the areas that were evaluated, no deficiencies were cited during today's inspection.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
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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