<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393619986
Report Date: 06/17/2019
Date Signed: 06/17/2019 12:33:20 PM

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:LOUIS VILLALOVOZ CDCFACILITY NUMBER:
393619986
ADMINISTRATOR:ZILLER, CHRISTYFACILITY TYPE:
850
ADDRESS:1550 CYPRESS DRIVETELEPHONE:
(209) 834-1850
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:43CENSUS: 11DATE:
06/17/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Christy ZillerTIME COMPLETED:
12:50 PM
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) Mary Ponce met with director Christy Ziller for a Case Management- Other inspection regarding a Confirmation of Removal for an adult working in the program. During the inspection, LPA toured all areas of the program. LPA Ponce did not observe the excluded individual in the facility. The Director stated that as of May 24th, the individual was on leave, and will remain out of the program until an exemption is approved.

No deficiencies cited during today's inspection. Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2019
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