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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701078
Report Date: 12/01/2022
Date Signed: 12/05/2022 09:47:36 AM

Document Has Been Signed on 12/05/2022 09:47 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:
12/01/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Julian Hawes TIME COMPLETED:
03:30 PM
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On 12/1/2022 at 2:00pm, Licensing Program Manager (LPM) Stephen Richardson and Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct a Plan of Correction (POC) visit. LPM Richardson and LPA Pascua were greeted by Myra Aguilar and was asked to call Facility Designated Administrator, Julian Hawes to let him know that CCL was present at this time. There were two another staff members present, Alena Halsne and Norma Borges.

The purpose of this visit was to follow up on the prior deficiencies and plan of corrections that were due on 10/04/2022 from a prior annual visit conducted on 08/30/2022 and case management visit conducted on 09/30/2022.

As of the date of this visit, 12/01/2022, the department had not received any forms or documents to support the plan of the correction and has been completed by this facility and its designated Administrator at this time.

An immediate civil penalty in the amount of $22,800 was assessed for violations of Sections 85076(d)(1), 80087(a) and 80036(e) for the time between 10/05/2022-12/1/2022. This civil penalty was due to not clearing the Plan of Correction (POC) by POC date 10/04/2022. The Facility Designated Administrator 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, a copy of this report, LIC421FC, and appeals rights were provided to the qfacility designated Administrator, Julian Hawes.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2022
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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