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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700754
Report Date: 10/13/2023
Date Signed: 10/13/2023 12:30:34 PM

Document Has Been Signed on 10/13/2023 12:30 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: 3DATE:
10/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Norma Borges TIME COMPLETED:
01:00 PM
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On 10/13/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Renee Campbell arrived unannounced to this facility to conduct a case management visit. LPAs met with Facility Designated Administrator (FDA), Norma Borges and explained the purpose of the visit. The purpose of this visit is in response to the Pre-Licensing Visit conducted on 10/13/2023.

During the Pre-Licensing visit conducted on 10/13/2023, LPAs observed the ring doorbell was not in working condition at this time. It was stated by facility staff that the doorbell needed to be removed or recharged. Facility staff stated that this was on the list of items to do before the change of ownership. LPAs also observed a large dent on the left side of the garage. It was stated by facility staff that a resident kicked the garage door. It was stated that the facility has already they have hired a handy man and is in the process of fixing the garage door.

Based on the observations made during this visit, a technical advisory has been provided for Section 80087(a).

An exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2023
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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