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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700109
Report Date: 09/19/2023
Date Signed: 09/19/2023 10:17:04 AM

Document Has Been Signed on 09/19/2023 10:17 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:DELTA AT THE SHERWOODSFACILITY NUMBER:
392700109
ADMINISTRATOR:TANYA MONGEFACILITY TYPE:
740
ADDRESS:1215 W SWAIN ROADTELEPHONE:
(209) 689-3180
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 42CENSUS: 41DATE:
09/19/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Craig VinceletTIME COMPLETED:
10:25 AM
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On 9/19/23 at approximately 9:30am Licensing Program Analysts (LPAs) Maja Jensen and Kesha Lewis arrived at facility unannounced to conduct a Plan of Correction (POC) visit. LPAs Jensen and Lewis met with site manager Craig Vincelet and explained the purpose of today's visit.

On 9/6/23 LPA Jensen issued a citation in relation to reporting requirements with a POC as follows:
The Licensee agrees to send a signed attestation to maja.jensen@dss.ca.gov that the regulation has been read, understood and will be complied with by POC due date. The POC due date was listed as 9/13/23 and to date has not been received.

Civil penalties are being assessed for failure to correct deficiencies.

An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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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