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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317185
Report Date: 10/16/2024
Date Signed: 10/18/2024 08:27:07 AM

Document Has Been Signed on 10/18/2024 08:27 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:UNITED CEREBRAL PALSY OF SAN JOAQUIN CO.FACILITY NUMBER:
390317185
ADMINISTRATOR/
DIRECTOR:		CORINNE FIELDERFACILITY TYPE:
775
ADDRESS:134 PACIFIC ROADTELEPHONE:
(209) 239-3066
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 40CENSUS: 29DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Francisca OronaTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Unannounced case management visit conducted on 10/16/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Francisca Orona.
A brief interview was conducted with the facility designated Administrator Francisca Orona at this time.
Current census was 29 residents.
The purpose of this case management visit was to follow up and inquire about a recent incident involving (2) participants where injuries were sustained. This LPA wanted to follow up and make sure that the day program, and it's staff, acted accordingly and addressed all issues during and after this incident took place.

There were no deficiencies observed or cited during the course of this case management visit.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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