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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701078
Report Date: 07/24/2023
Date Signed: 07/25/2023 11:32:34 AM

Document Has Been Signed on 07/25/2023 11:32 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 CARE #2FACILITY NUMBER:
502701078
ADMINISTRATOR:HAWES, JULIANFACILITY TYPE:
735
ADDRESS:408 FAIRWAY DRIVETELEPHONE:
(510) 320-2800
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 4CENSUS: 4DATE:
07/24/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Norma BorgesTIME COMPLETED:
03:00 PM
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On 07/24/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Christina Valerio arrived unannounced to this facility to conduct a Plan of Correction (POC) visit. LPAs met with Staff Member (SM), Norma Borges and explained the purpose of the visit. LPA Pascua asked that SM Borges call the Facility Designated Administrator (FDA), Julian Hawes, and inform him that Community Care Licensing was present at the facility and inform him of the purpose of the visit. It was learned that FDA Hawes was unable to come at the facility at this time. LPAs continued the visit with SM Borges.

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 case management visit conducted on 06/29/2023. As of the date of this visit, 07/24/2023, the department has not received any forms or documents to support that the plan of correction has been completed by this facility and its designated Administrator at this time.

  • A civil penalty in the amount of $1,700 was assessed for violations of Section 80044(a)(2) for the time between 07/08/2023-07/24/2023. This civil penalty was due to failure to correct the deficiency by the Plan of Correction date 06/29/2023. The Facility was informed that the civil penalty will continue to accrue $100 per day per violation until the deficiency is corrected.
  • A civil penalty in the amount of $1,700 was assessed for violations of Section 85064(j)(3) for the time between 07/08/2023-07/24/2023. This civil penalty was due to failure to correct the deficiency by the Plan of Correction date 06/29/2023. The Facility 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 and a copy of this report was provided to the facility at the end of this visit. A copy of the report was also emailed to the Facility Designated Administrator read receipt confirmed receiving these documents.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2023
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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