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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
079201312
Report Date:
05/17/2024
Date Signed:
05/17/2024 12:18:15 PM
Document Has Been Signed on
05/17/2024 12:18 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:
OASIS SUNSHINE CARE HOME
FACILITY NUMBER:
079201312
ADMINISTRATOR/
DIRECTOR:
STANIFER, TRACY
FACILITY TYPE:
735
ADDRESS:
2311 CRYSTAL AVENUE
TELEPHONE:
(707) 590-3905
CITY:
CONCORD
STATE:
CA
ZIP CODE:
94520
CAPACITY:
6
CENSUS:
0
DATE:
05/17/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
11:09 AM
MET WITH:
Tracy Stanifer, Licensee
TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analysts (LPAs) Jill Clancy-Czuleger conducted an announced Component III Training. Component III was attended by Tracy Stanifer (applicant-administrator). LPA presented the training via Power Point presentation and had a discussion with applicants.
Exit interview conducted and copy of this report provided at the conclusion of the training
SUPERVISORS NAME
:
Harpreet Humpal
LICENSING EVALUATOR NAME
:
Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE
:
DATE:
05/17/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/17/2024
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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