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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700754
Report Date: 08/24/2023
Date Signed: 08/27/2023 02:23:14 PM

Document Has Been Signed on 08/27/2023 02:23 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:DREAM CAREFACILITY NUMBER:
502700754
ADMINISTRATOR:NORMA BORGESFACILITY TYPE:
735
ADDRESS:2004 KRUGER DRIVETELEPHONE:
(209) 661-4666
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 4CENSUS: 4DATE:
08/24/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Norma Borges TIME COMPLETED:
03:00 PM
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On 08/24/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Christina Valerio arrived unannounced Plan of Correction (POC) visit. LPAs met with Facility Designated Administrator (FDA), Norma Borges and explained the purpose of the visit.
The purpose of this visit was to clear deficiencies previously cited on 06/01/2023, 06/02/2023, 06/15/2023, 06/26/2023, and 06/29/2023.

Current Census was 4. A tour of the facility was conducted. A brief interview with HM Borges was conducted.

Plan of correction letters were generated and a copy was given to the facility at this time.

An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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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