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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004560
Report Date: 04/07/2023
Date Signed: 04/07/2023 10:27:19 AM


Document Has Been Signed on 04/07/2023 10:27 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: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: 0DATE:
04/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Johnny ColladoTIME COMPLETED:
10:30 AM
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On 04/07/2023 at 10:00 AM, Licensing Program Analyst (LPA) Avelina Martinez arrived at facility to conduct a facility closure visit. LPA Martinez met with Johnny Collado and explained the purpose of today's visit.

The purpose of today's visit is in response to closing the facility. LPA Martinez toured the facility with Johnny Collado, and LPA Martinez observed no residents in the facility. LPA Martinez obtained the facility license at today's visit. As of April 7 2023, the facility is closed.

Licensee was informed about the closure visit survey, and website was provided to the Licensee.https://www.surveymonkey.com/r/facilityclosure



A exit interview was conducted, and a copy of this report was provided to Johnny Collado.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2023
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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