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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317652
Report Date: 11/12/2024
Date Signed: 11/12/2024 03:19:49 PM

Document Has Been Signed on 11/12/2024 03:19 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:MCKINLEY ELEMENTARY SCHOOLFACILITY NUMBER:
390317652
ADMINISTRATOR/
DIRECTOR:		HAGEDORN, JOAQUINFACILITY TYPE:
850
ADDRESS:30 W. NINTH STREET, ROOM ATELEPHONE:
(209) 933-7245
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
11/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:48 PM
MET WITH:Teacher Lily GutierrezTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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On 11/12/24, Licensing Program Analyst (LPA) Carla Polanco met with Teacher Lily Gutierrez to follow up on a Unusual Incident Report (UIR) called into Community Care Licensing on 10/28/24. During today's inspection LPA conducted a tour of the facility, conducted an interview with Lead Teacher and obtained information pertinent to the incident.

Facility evaluation report was reviewed and discussed with Lead Teacher. Exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
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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