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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201302
Report Date: 11/17/2023
Date Signed: 11/17/2023 02:18:16 PM

Document Has Been Signed on 11/17/2023 02:18 PM - 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:WARNER HOME #3FACILITY NUMBER:
019201302
ADMINISTRATOR:SLOAN, PAMELAFACILITY TYPE:
735
ADDRESS:36951 MULBERRY STREETTELEPHONE:
(831) 917-2870
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 6CENSUS: 0DATE:
11/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Pamela SloanTIME COMPLETED:
02:30 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
On this day, Licensing Program Analyst (LPA) Luisa Fontanilla conducted Component lll with Applicant Pamela Sloan.

LPA went over with applicant Power Point presentation. LPA provided applicant with LPA information.

A copy of this report was provided to the applicant.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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