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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393604033
Report Date: 09/13/2024
Date Signed: 09/13/2024 10:02:09 AM

Document Has Been Signed on 09/13/2024 10:02 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 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: 16DATE:
09/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Maria RetamozaTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 09/13/24, Licensing Program Analyst (LPA)Elvira Sierra met with lead teacher,Maria Retamoza to follow up on an Unusual Incident Report (UIR) occurred on 08/14/24. During today's visit the facility was toured. Present were 16 children in care, 3 staff and one volunteer.

The facility reported the UIR to Community Care Licensing within 24hrs. A written UIR was submitted within 7 days, describing the specifics of the incident.



Facility evaluation report was reviewed and discussed with facility representative, Maria Retamoza. Exit interview was conducted. A notice of site visit was posted 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: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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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