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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622447
Report Date: 06/13/2023
Date Signed: 06/13/2023 04:09:30 PM

Document Has Been Signed on 06/13/2023 04:09 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:RUIZ, SANTOSFACILITY NUMBER:
393622447
ADMINISTRATOR:RUIZ, SANTOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 594-0132
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
06/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee: Ruiz, SantosTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Mariya Melnichuk met with Licensee, Santos Ruiz to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 06/08/2023. During today's visit the facility was toured. Present were 8 children in care and 2 staff.

LPA interviewed the Assistant who was present during the incident and the two children. LPA reviewed and discussed this report with the licensee.

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.

Licensee stated that there is a child who is working on spatial awareness and the child hit the other child her by accident. Licensee followed up with the concerned parent and spoke to her about safety and supervision. Licensee stated that she has been using surveillance cameras in the play room and living room. Licensee stated that her facility maintains 100% supervision with the children at all times and she addresses behavior concerns with the children and parents.

Facility evaluation report was reviewed and discussed with the Licensee. 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.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Mariya Melnichuk
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
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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