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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621114
Report Date: 09/13/2024
Date Signed: 09/13/2024 03:01:45 PM

Document Has Been Signed on 09/13/2024 03:01 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:WESTGATE - SUSD HEAD STARTFACILITY NUMBER:
393621114
ADMINISTRATOR/
DIRECTOR:		KELLER, DEBRAFACILITY TYPE:
850
ADDRESS:6119 DANNY DRIVETELEPHONE:
(209) 474-7471
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 10DATE:
09/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:52 PM
MET WITH:Facility Representative, LisaTIME VISIT/
INSPECTION COMPLETED:
03:08 PM
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On September 13,2024, Licensing Program Analysts (LPA) Elizabeth Santiago met with Facility Representatives Lisa Constant and Nora Touque to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 09/13/2024. During today's visit the facility was toured. Present were 10 children in care and 2 staff.

LPA interviewed the facility representative who was present during the incident. LPA reviewed and discussed this report with both facility representatives. LPA obtained a copy of the facility roster, sign in and outs, and personnel report.

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 Representatives Lisa Constant and Nora Touque. Exit interview was conducted. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Elizabeth Santiago
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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