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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004560
Report Date: 10/17/2022
Date Signed: 10/17/2022 01:41:49 PM


Document Has Been Signed on 10/17/2022 01:41 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:ST. LUKE'S RESIDENTIAL FACILITYFACILITY NUMBER:
347004560
ADMINISTRATOR:COLLADO, JOHNNYFACILITY TYPE:
740
ADDRESS:4127 RIO LINDA BLVD.TELEPHONE:
(916) 568-9696
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:6CENSUS: 2DATE:
10/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:24 PM
MET WITH:Celia Collado TIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Avelina Martinez arrived at facility unannounced to conduct a case management visit on 10/17/2022. LPA met with Celia Collado and explained the purpose of the visit.

The purpose of today's visit is in response to the closure of this facility. The licensee is working with a referral agencies to find placement for two residents, and has implemented a closure plan. LPA Martinez will return to the facility to conducted a final closure visit. There were no deficiencies cited at this visit. An exit interview was conducted, and a copy of this report was given to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2022
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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