Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393610932
Report Date: 04/03/2018
Date Signed: 04/03/2018 09:15:56 AM

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.250
SACRAMENTO, CA 95833
FACILITY NAME:CAPC-CENTRAL 1FACILITY NUMBER:
393610932
ADMINISTRATOR:KIM PAWLOWICZFACILITY TYPE:
850
ADDRESS:540 N. CALIFORNIA ST.TELEPHONE:
(209) 644-5323
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY:56CENSUS: 36DATE:
04/03/2018
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Liz RogersTIME COMPLETED:
09:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) met with Liz Rogers, Director of Business Operations, for a Case Management inspection.

The facility has recently removed a wall in Classroom #148 to extend the space. A wall has been added on the other side, in Classroom #143, which lost the rectangular space that was lost in Room 148.

No measurements were taken today, as the square footage and capacity are not changing. An updated facility sketch will be submitted to licensing.

An exit interview was conducted with Ms. Rogers in which the report was reviewed.
A Notice of Site Visit was posted. No deficiencies were cited at today's inspection.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Bettina EngelmanTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1