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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700180
Report Date: 02/03/2021
Date Signed: 02/03/2021 10:35:14 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:DULAY GUEST HOME 1FACILITY NUMBER:
392700180
ADMINISTRATOR:DAVIS, ARVINFACILITY TYPE:
740
ADDRESS:663 CHICAGO AVETELEPHONE:
(209) 482-8230
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 0DATE:
02/03/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Luvie, Mendoza, AdministratorTIME COMPLETED:
09:50 AM
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Licensing Program Analyst Bruce Jacobs conducted a tele-inspection at the care home and met with Administrator Luvie Mendoza. She stated it was her intentions to close this home and a new applicant will operate the home. She stated she had previously sent correspondence to Community Care Licensing Regional Office and to Program Administration. 60 day notices were provided to resident and the last resident was relocated on 1/29/20. LPA conducted a visual inspection of the home and verified that there were no residents or personal belongings were observed in the home. Luvie Mendoza agreed to send in the physical license along with a statement to this LPA requesting to close the home
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce JacobsTELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2021
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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