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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701078
Report Date: 09/18/2023
Date Signed: 09/20/2023 08:41:34 AM

Document Has Been Signed on 09/20/2023 08:41 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:NORMA BORGESFACILITY TYPE:
735
ADDRESS:408 FAIRWAY DRIVETELEPHONE:
(510) 320-2800
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 4CENSUS: 4DATE:
09/18/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Norma Borges TIME COMPLETED:
11:30 AM
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On 09/18/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Christina Valerio arrived to this facility unannounced to conduct a Plan of Correction (POC) visit. LPAs were greeted by Facility Designated Administrator, Norma Borges and explained the purpose of the visit.
Current census was 4. A brief interview with FDA Borges was conducted.

The purpose of this visit to follow up on the deficiencies cited conducted on 06/15/2023 and 06/29/2023. The department received a POC letter on 08/21/2023.
  • A civil penalty in the amount of $2,700 was assessed for violations of Section 80044(c) for the time between 07/25/2023-08/20/2023. This civil penalty was due to failure to correct the deficiency by the Plan of Correction date 06/16/2023.
  • A civil penalty in the amount of $5,400 was assessed for violations of 80044(a)(2) and 85064(j)(3) for the time between 7/25/2023-08/20/2023. This civil penalty was due to failure to correct the Plan of Correction by the POC date on 06/30/2023.


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: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2023
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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