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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
390312403
Report Date:
06/18/2021
Date Signed:
06/29/2021 06:33:01 AM
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:
GOLDEN HAVEN
FACILITY NUMBER:
390312403
ADMINISTRATOR:
ROWENA RAMIREZ
FACILITY TYPE:
740
ADDRESS:
2324 LEVER BLVD.
TELEPHONE:
(209) 464-4743
CITY:
STOCKTON
STATE:
CA
ZIP CODE:
95206
CAPACITY:
150
CENSUS:
40
DATE:
06/18/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:00 PM
MET WITH:
Christine Thombare
TIME COMPLETED:
12:32 PM
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LPA arrived and was informed by staff that the annual was completed on 6/11/2021 by LPA Bilger.
No other information at this time.
LPA Johnson ended the visit no deficiencies observed or cited.
SUPERVISOR'S NAME:
Stephenie Doub
TELEPHONE:
(916) 263-2131
LICENSING EVALUATOR NAME:
Albert Johnson
TELEPHONE:
(916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE:
06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/18/2021
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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