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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700754
Report Date: 06/26/2023
Date Signed: 06/28/2023 10:38:38 AM

Document Has Been Signed on 06/28/2023 10:38 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:
06/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Andrea Rush TIME COMPLETED:
02:00 PM
NARRATIVE
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On 06/26/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Christina Valerio arrived unannounced to conduct a complaint visit. LPAs were greeted by Staff Member (SM) Andrea Rush and explained the purpose of the visit. LPA Pascua asked that SM Rush call the Facility Designated Administrator (FDA) and inform them that CCL was present at this time. LPA Pascua learned that FDA, Julian Hawes, was unable to make it to the facility at this time. LPAs continued the visit with SM Rush. The purpose of this visit was to deliver complaint findings for the allegations above.

The purpose of this visit was to provide the facility a copy of a Non-Compliance Letter informing the Licensee that a meeting will take place on Wednesday, 06/28/2023. A previous letter was sent out via certified mail on 06/09/2023.

An exit interview was held, and a copy of the report was provided.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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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