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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700754
Report Date: 07/07/2023
Date Signed: 07/11/2023 08:30:36 AM

Document Has Been Signed on 07/11/2023 08:30 AM - 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:DREAM CAREFACILITY NUMBER:
502700754
ADMINISTRATOR:HAWES, JULIANFACILITY TYPE:
735
ADDRESS:2004 KRUGER DRIVETELEPHONE:
(209) 661-4666
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 4CENSUS: 4DATE:
07/07/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Andrea Rush TIME COMPLETED:
01:00 PM
NARRATIVE
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On 07/07/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Kesha Lewis arrived unannounced to this facility to conduct as Plan of Correction (POC) visit. LPA Pascua and Lewis were greeted by staff member, Andrea Rush and asked to call the Facility Designated Administrator, Julian Hawes to let him know that CCL was present at this time. Shortly after, LPA Pascua spoke to FDA Hawes via telephone and explained the purpose of the visit. LPA Pascua was informed that FDA Hawes could not make the visit and and asked LPAs to continue the visit with SM Rush. Current Census was 4

The purpose of this visit was to follow up on the prior deficiencies and plan of corrections that were due on 06/30/2023 from a prior complaint visit conducted on 06/02/2023.

As of the date of this visit, 07/07/2023, the department had not received any forms or documents to support the plan of the correction and has not been completed by this facility and its designated Administrator at this time.



An immediate civil penalty in the amount of $250 was assessed for violations of 80087(a). This civil penalty was due to a repeat violation. The Facility Designated Administrator was informed that the civil penalty will continue to accrue $100 per day per violation until the deficiency is corrected.

An exit interview was conducted, a copy of this report, and appeals rights was provided to the Facility Designated Administrator,Julian Hawes and staff member, Andrea Rush via email. An electronic email read receipt confirms receiving these documents.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2023
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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