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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701211
Report Date: 09/05/2023
Date Signed: 09/05/2023 11:21:38 AM

Document Has Been Signed on 09/05/2023 11:21 AM - 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:STEWART OAKS VILLAFACILITY NUMBER:
342701211
ADMINISTRATOR:FERREIRA, MELANIEFACILITY TYPE:
740
ADDRESS:1099 STEWART ROADTELEPHONE:
(916) 222-1010
CITY:SACRAMENTOSTATE: CAZIP CODE:
95864
CAPACITY: 6CENSUS: 4DATE:
09/05/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:58 AM
MET WITH:Jennifer Campos TIME COMPLETED:
11:30 AM
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On September 05, 2023, Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a case management visit. LPA met with Jennifer Campos and explained the purpose of the visit.

The purpose of this case management is to follow up on extended plan of corrections. LPA Martinez cleared the plan of corrections (POC) and provided POC Letters to Jennifer Campos. LPA Martinez will continue to follow up with the facility and conduct case management visits. The current census is four, and staffing is adequate at this time. Additional staffing will be added if census increases. An exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2023
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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