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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390332359
Report Date: 05/21/2024
Date Signed: 05/21/2024 01:39:33 PM

Document Has Been Signed on 05/21/2024 01:39 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HANOT FOUNDATIONFACILITY NUMBER:
390332359
ADMINISTRATOR/
DIRECTOR:		REEVES, LAURA L.FACILITY TYPE:
735
ADDRESS:14373 EAST SARGENTTELEPHONE:
(209) 334-6454
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 30CENSUS: 23DATE:
05/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:23 PM
MET WITH:Tanya NewtonTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On May 21, 2024 at 12:23 PM, Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a case management visit. LPA Martinez met with Tanya Newton and explained the purpose of the visit.

The purpose of the visit today is in response to behavior incidents regarding client 1 (C1). LPA Martinez conducted a file review and obtained facility records. LPA Martinez will return at a later date to follow up on this case management.

As a result of this case management, there were no deficiencies cited. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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