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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804206
Report Date: 04/26/2024
Date Signed: 04/26/2024 03:43:54 PM

Document Has Been Signed on 04/26/2024 03:43 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SUCCESSFUL STRIDES INCFACILITY NUMBER:
486804206
ADMINISTRATOR/
DIRECTOR:		REESE, LORIFACILITY TYPE:
735
ADDRESS:106 SERRA DRIVETELEPHONE:
(650) 269-2328
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 4CENSUS: 0DATE:
04/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:52 PM
MET WITH:Lori ReeseTIME VISIT/
INSPECTION COMPLETED:
01:23 PM
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Licensing Program Analyst (LPA) Araceli Canela arrived to conduct a continuation of a pre-licensing inspection and was greeted by Applicant/Administrator, Lori Reese.

The reason of the visit was to confirm that individuals who were living in the home and were part of a Foster License had moved from this home.
LPA observed and confirmed the individuals had moved out.


Prelicensing is complete.

LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status.

No Deficiencies or Advisories given during visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Araceli Canela
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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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