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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004560
Report Date: 02/06/2023
Date Signed: 02/06/2023 04:08:04 PM


Document Has Been Signed on 02/06/2023 04:08 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:
02/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Johnny ColladoTIME COMPLETED:
04:15 PM
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On 02/06/2022 at 3:35 PM, Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a case management visit on 02/06/2022. LPA met with Johnny Collado and explained the purpose of today's visit.

The purpose of today's visit is in response to follow up on the closure of this facility and resident placement. 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: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
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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