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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313621978
Report Date: 01/31/2024
Date Signed: 01/31/2024 12:03:04 PM

Document Has Been Signed on 01/31/2024 12:03 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:STAR CARLIN C. COPPINFACILITY NUMBER:
313621978
ADMINISTRATOR:ASHLEIGH WEATHERLYFACILITY TYPE:
840
ADDRESS:150 E. 12TH STREETTELEPHONE:
(916) 632-8407
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 3DATE:
01/31/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kristina FiffickTIME COMPLETED:
12:25 PM
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On January 31, 2024, Licensing Program Analysts (LPA) Lea Habtom met with Designated Representative, Kristina Fiffick, for the purpose of a case management inspection. Upon arrival, LPA observed a census of 3 transitional kindergarten children being supervised by 1 staff and the designated representative. All individuals subject to criminal background review have obtained criminal record clearance.

The facility wishes to add pod #E and keep the capacity of 60 between pod #K & pod #E. Children will be utilizing the toilets and sinks that are located on the school campus of Carlin C. Coppin Elementary School. Cubbies were not observed but the designated representative stated 30 are in storage at the warehouse. The cubbies will be moved to pod #E by February 2, 2024.

Outdoor Activity Space
The facility will be utilizing the elementary school playground.

Effective today, Wednesday, January 31, 2024 LPA is granting a room addition to pod #E.

There were no deficiencies cited during today's inspection. An exit interview was conducted with designated representative, Kristina Fiffick. Notice of Site Visit was provided and shall remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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