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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621652
Report Date: 06/10/2025
Date Signed: 06/10/2025 12:04:58 PM

Document Has Been Signed on 06/10/2025 12:04 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:COUNTRY CLUB EARLY CARE & LEARNING CENTERFACILITY NUMBER:
393621652
ADMINISTRATOR/
DIRECTOR:		GRIEGO, KARENFACILITY TYPE:
850
ADDRESS:2448 COUNTRY CLUB BOULEVARDTELEPHONE:
(209) 941-9100
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 52DATE:
06/10/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Griego, KarenTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) David Nguyen met facility representative, Karen Griego, to conduct a proof-of-correction inspection to verify corrections of two (2) Type-A deficiencies cited on June 4th, 2025. The purpose of the proof-of-correction inspection was explained. There were fifty-two (52) children present being supervised by nine (9 ) childcare teachers during today’s proof-of-correction inspection.

On June 4th, 2025, the childcare facility was cited for one (1) Type-A deficiency for two (2) bodies of water on the premises. During the inspection on June 4th, 2025, LPA observed two (2) water tables filled with water and water toys left unattended outside on the playground. During today's inspection LPA toured on-limits areas. The Type-A deficiency cited on June 4th, 2025, for two (2) bodies of water on the premises was cleared on June 10th, 2025. LPA Nguyen observed no bodies of water on the premises. In addition, LPA Nguyen received the sign-in sheet of teachers’ meeting and teachers’ meeting agenda, which was held on June 5th, 2025, from facility representative during today’s inspection.

In addition, on June 4th, 2025, the childcare facility was cited for one (1) Type-A deficiency for two (2) children’s medications stored in the plastic bags without original boxes and proper pharmacy labels. During today’s inspection, LPA reviewed the storage of medication and equipment and supplies. LPA observed that children’s medications were stored properly with their original boxes and intact pharmacy labels. The Type-A deficiency cited on June 4th, 2025, for two (2) children’s medications stored in plastic bags without the original boxes and pharmacy labels was cleared on June 10th, 2025.

Report continues on LIC809-C... (Page 2)

NAME OF LICENSING PROGRAM MANAGER: Chayntel Hunter
NAME OF LICENSING PROGRAM ANALYST: David Nguyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: COUNTRY CLUB EARLY CARE & LEARNING CENTER
FACILITY NUMBER: 393621652
VISIT DATE: 06/10/2025
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(Page 2)
An exit interview was conducted with facility representative, Karen Griego. Appeal rights and a Notice of Site Visit were provided. Facility representative’s signature on this form acknowledged the receipt of the form. A notice of site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
NAME OF LICENSING PROGRAM MANAGER: Chayntel Hunter
NAME OF LICENSING PROGRAM ANALYST: David Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC809 (FAS) - (06/04)
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