393611181-9-26-2024-53-CC-DNGN-D9GREW-20240926125814

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393611181
Report Date: 09/26/2024
Date Signed: 09/26/2024 12:58:17 PM

Document Has Been Signed on 09/26/2024 12:58 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:	STOCKTON UNIFIED SCHOOL DISTRICT-WILSON STATE		FACILITY NUMBER:	393611181
ADMINISTRATOR/ DIRECTOR:	STARLYN BROWN		FACILITY TYPE:	850
ADDRESS:	150 E. MENDOCINO		TELEPHONE:	(209) 933-7325
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 20	CENSUS: 8	DATE:	09/26/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Garcia, Noemi		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

NARRATIVE

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On September 26th, 2024, at 11:30 AM, Licensing Program Analysts (LPAs), David Nguyen and Janie Davis conducted an unannounced field visit to the facility. Both LPA Nguyen and LPA Davis were granted entry into the facility by facility representative, Noemi Garcia. LPA Nguyen met with Facility Representative, Noemi Garcia to follow up on the written Unusual Incident Report (UIR) was submitted to Community Care Licensing Division (CCLD) via email on September 4th, 2024.

LPA toured the facility, observed the care and supervision of children, reviewed records, and conducted onsite interview with teachers. During today’s field visit, LPA toured the facility and observed eight (8) children being supervised by two (2) teachers.

Facility evaluation report was reviewed and discussed with Facility Representative, Noemi Garcia. Exit interview was conducted. A Notice of Site Visit was provided 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: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

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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