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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317004468
Report Date: 04/24/2024
Date Signed: 06/10/2024 11:09:21 AM

Document Has Been Signed on 06/10/2024 11:09 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DREAM THEATRE INC.FACILITY NUMBER:
317004468
ADMINISTRATOR/
DIRECTOR:		WHEELER, MICHELLEFACILITY TYPE:
775
ADDRESS:501 DEREK PLACE, SUITE 160TELEPHONE:
(916) 780-2090
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 45CENSUS: 37DATE:
04/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Michelle WheelerTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 4/24/24 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit. Administrator is present to assist with the inspection.

LPA toured the interior of the facility together with Admin to ensure health and safety of residents in care. Areas toured include but are not limited to: classrooms, common areas, bathroom, kitchen. In the areas toured no immediate health, safety, or personal rights violations were observed. The program is very clean and well maintained.

LPA reviewed 4 client files. Files are complete.

LPA reviewed 2 staff files. Files are complete.

Licensee is updating the following and will submit copies of: LIC 500,LIC 308, updated lease, emergency and infection control plans.

No deficiencies are being cited as a result of todays inspection.


Exit interview conducted with licensee and copy of report left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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