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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393611617
Report Date: 08/21/2023
Date Signed: 08/21/2023 02:27:06 PM

Document Has Been Signed on 08/21/2023 02:27 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EL CONCILIO PRESCHOOL & INFANT CENTERFACILITY NUMBER:
393611617
ADMINISTRATOR:LINDA CRAIGFACILITY TYPE:
850
ADDRESS:4701 FARMINGTON ROADTELEPHONE:
(209) 462-7846
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY: 44TOTAL ENROLLED CHILDREN: 17CENSUS: 11DATE:
08/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Yath VonTIME COMPLETED:
03:00 PM
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On August 21, 2023, Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of conducting a case management inspection. LPA met with Facility Representative, Yath Von. LPA observed eleven children supervised by three staff. Criminal record clearances were verified.

LPA discussed an unusual incident that was submitted to the Worker of the Day line on July 26, 2023. LPA conducted interviews and obtained documents during today's inspection.

Exit interview conducted at which time the report was reviewed with Facility Representative, Yath Von. A Notice of Site Visit was posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2023
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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