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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701078
Report Date: 06/15/2023
Date Signed: 06/23/2023 09:09:26 AM

Document Has Been Signed on 06/23/2023 09:09 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:
06/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Norma BorgusTIME COMPLETED:
03:00 PM
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On 06/15/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Christina Valerio arrived unannounced to this facility to conduct a case management visit. LPAs were greeted by staff member (SM), Norma Borgus and explained the purpose of the visit. LPA Pascua asked for SM Borgus to go ahead and call the Facility Designated Administrator (FDA), Julian Hawes to inform him that CCL was present. It was at this time that LPAs learned that FDA Hawes was unable to come to the facility. LPAs continued the visit with SM Borgus.

Current Census was 4. A brief interview with SM Borgus was conducted.

The purpose of this visit is to follow up on the documentation that was requested by the audits department on a previous case management visit on 06/02/2023 and was due to LPA Pascua's email on 06/08/2023. As of the date of this visit, 06/15/2023, the department has not received documentation.

Though the facility did not provide documentation, the facility has been cited for this deficiency on a prior case management visit on 06/15/2023 due. An exit interview was conducted and a copy of this report was provided to the facility via email and an electronic email read receipt confirms receiving these documents.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2023
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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