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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393607283
Report Date: 03/05/2025
Date Signed: 03/05/2025 02:26:10 PM

Document Has Been Signed on 03/05/2025 02:26 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:ADAMS ELEMENTARY SCHOOLFACILITY NUMBER:
393607283
ADMINISTRATOR/
DIRECTOR:		TIM SWARTZFACILITY TYPE:
850
ADDRESS:6402 INGLEWOOD AVE.TELEPHONE:
(209) 933-7153
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 24DATE:
03/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:kellany MendozaTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 03/05/25, Licensing Program Analysts (LPAs) Elvira Sierra and Stacey Williams met with Lead Teacher, Kellany Mendoza for the purpose of a case management visit regarding an unusual incident occurred 02/27/25 that was self-reported by the facility to Community Care Licensing. LPA toured the facility, observed the care and supervision of children, reviewed records and conducted interviews.Present in the facility were 24 children being supervised by five staff and five School District paraprofessionals.

No deficiencies were cited during this visit. Exit interview conducted. This report and Appeal of Rights were provided to facility representative, Kellany Mendoza. A notice of site visit posted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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