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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393604033
Report Date: 08/22/2024
Date Signed: 08/22/2024 03:33:09 PM

Document Has Been Signed on 08/22/2024 03:33 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:COLONIAL HEIGHTS STATE PRESCHOOLFACILITY NUMBER:
393604033
ADMINISTRATOR/
DIRECTOR:		ARDELEAN, GRETCHENFACILITY TYPE:
850
ADDRESS:8135 BALBOA AVENUETELEPHONE:
(209) 953-8734
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 9DATE:
08/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Reina KavanaghTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 08/22/24, Licensing Program Analyst (LPA)Elvira Sierra met with Preschool Specialist, Reina Kavanagh for the purpose of conducting an unannounced case management inspection to follow up on an Unusual Incident Report that occurred on 08/14/24. LPA observed nine children supervised by three staff members.

During today's visit LPA reviewed documents, conducted interviews, and observed the care and supervision of the children.

Due to insufficient information available at this time, incident needs further investigation.



An exit Interview was conducted in which the report was reviewed and discussed with Facility Representative, Reina Kavanagh. A copy of the report was provided, and a notice of site visit was posted.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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