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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700706
Report Date: 06/20/2024
Date Signed: 06/20/2024 11:13:04 AM

Document Has Been Signed on 06/20/2024 11:13 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MONTANA HOMESFACILITY NUMBER:
392700706
ADMINISTRATOR/
DIRECTOR:		BISHOP, KIMBERLYFACILITY TYPE:
735
ADDRESS:4442 MIST TRAIL DRTELEPHONE:
(209) 242-2583
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 5CENSUS: 3DATE:
06/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:27 AM
MET WITH:Kimberly BishopTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 6-20-24 at 10:27am, Licensing Program Analyst (LPA) arrived unannounced to conduct a case management visit regarding applicable laws and regulations. LPA met with Administrator Kimberly Bishop and explained the purpose of the visit.

During today's visit, LPA retrieved a physical copy of an email from Department of Labor stating "Department is taking nonenforcement position under the Fair Labor Standards Act (FLSA); therefore, our Department will be closing it's case today with no findings." Email is dated 4-5-24.

An exit interview was conducted with Kimberly Bishop and a copy of this report was provided to Kimberly.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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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