<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393600244
Report Date: 09/11/2025
Date Signed: 09/11/2025 02:53:46 PM

Document Has Been Signed on 09/11/2025 02:53 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:ANNUNCIATION PRESCHOOLFACILITY NUMBER:
393600244
ADMINISTRATOR/
DIRECTOR:		SHANNON RODRIGUEZFACILITY TYPE:
850
ADDRESS:440 WEST ROSE STREETTELEPHONE:
(209) 465-2961
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY: 36TOTAL ENROLLED CHILDREN: 44CENSUS: 30DATE:
09/11/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Rodriguez, Shannon TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) David Nguyen met facility representative, Shannon Rodriguez, to conduct a proof-of-correction inspection to verify corrections of one (1) Type-B deficiency and two (2) Type-A deficiencies cited on September 5th, 2025. The purpose of the proof-of-correction inspection was explained. There were thirty (30) childcare children present being supervised by five (5) childcare teachers during today’s proof-of-correction inspection.

On September 5th, 2025, the childcare facility was cited for one (1) Type-B deficiency for not completing the child care provider mandated reporter trainings. During the inspection on September 5th, 2025, LPA reviewed staff records, and based on record reviews, staff members did not have valid child care provider mandated reporters in the files. In addition, the childcare facility was cited for two (2) Type-A deficiencies for not keeping the childcare center safe and in good repair and for leaving a childcare child without supervision of a childcare teacher. During the inspection on September 5th, 2025, LPA observed one (1) window air conditioner when in operation dripping water excessively on the playground, which was accessible to childcare children, and LPA observed a childcare child was left unattended in the bathroom as the child was washing hands.

During today’s inspection, LPA reviewed teachers’ files and children’s files. LPA observed teachers’ valid child care provider mandated reporter certificates in teachers’ files and signed LIC9224s—Acknowledgement of Receipt of Licensing Report in children children’s files. LPA, in addition, observed the window air conditioner, which was dripping condensation water excessively in the playground, has been replaced.

Report continues on LIC809-C... (Page 2)

NAME OF LICENSING PROGRAM MANAGER: Chayntel Hunter
NAME OF LICENSING PROGRAM ANALYST: David Nguyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ANNUNCIATION PRESCHOOL
FACILITY NUMBER: 393600244
VISIT DATE: 09/11/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Page 2)
Furthermore, LPA obtained the teachers’ meeting agenda, which stressed bathroom supervision, held on September 8th, 2025, as well as the teachers’ meeting sign-in sheet from the facility representative during today’s inspection. While LPA toured on-limits areas, LPA observed supervision and ratios were appropriate.

The Type-B deficiency cited on September 5th, 2025, for not completing the child care provider mandated reporter trainings was cleared on September 11th, 2025. In addition, the two (2) type-A deficiencies cited on September 5th, 2025, for not keeping the childcare center safe and in good repair and for leaving a childcare child without supervision of a childcare teacher were also cleared on September 11th, 2025.

The Proof-of-Correction Letters were provided. In the areas that were evaluated today, no deficiencies were observed or cited. An exit interview was conducted with facility representative, Shannon Rodriguez. Appeal rights and a Notice of Site Visit were provided. The facility representative’s signature on this form acknowledged the receipt of the form. A notice of site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

NAME OF LICENSING PROGRAM MANAGER: Chayntel Hunter
NAME OF LICENSING PROGRAM ANALYST: David Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3