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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700065
Report Date: 11/15/2023
Date Signed: 11/15/2023 05:03:17 PM

Document Has Been Signed on 11/15/2023 05:03 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WILTON STABLESFACILITY NUMBER:
342700065
ADMINISTRATOR:KOLU G SOKODOLOFACILITY TYPE:
735
ADDRESS:11119 MANN ROADTELEPHONE:
(916) 687-4548
CITY:WILTONSTATE: CAZIP CODE:
95693
CAPACITY: 4CENSUS: 4DATE:
11/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:AttemptedTIME COMPLETED:
10:00 AM
NARRATIVE
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LPA Jensen arrived at facility unannounced at 9:20am. LPA Jensen rang the door bell, knocked on the door, called the facility land line, called the Licensee's mobile phone and sent the Licensee a text message. At approximately 12pm the Regional Manager, Victor Cardona returned the calla nd made arrangements with the LPA to meet later in the afternoon.

A copy of this report was provided to Victor Cardona at the later meeting.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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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