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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317677
Report Date: 07/21/2023
Date Signed: 07/21/2023 11:15:17 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/21/2023 11:15 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:B W HOMEFACILITY NUMBER:
390317677
ADMINISTRATOR:WEAVER, LARHONDAFACILITY TYPE:
735
ADDRESS:9148 DON RAMONTELEPHONE:
(209) 513-6244
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 6CENSUS: 0DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensee not on siteTIME COMPLETED:
10:15 AM
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On 7-21-23 at 9:45am, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to conduct an annual inspection visit. LPAs arrived and observed 2 cars parked in drive way. LPAs also observed blinds shut. LPA's knocked on door and rang door bell but did not receive a response for 15 minutes. LPAs called and left message for Licensee but did not receive a response for an additional 15 minutes. Annual visit was unable to be completed as a result.

Report will be mailed to Licensee with a request for return with signature. Signature not obtained on-site due to absence of Licensee and designee.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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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