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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700306
Report Date: 06/23/2023
Date Signed: 06/23/2023 02:12:57 PM


Document Has Been Signed on 06/23/2023 02:12 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:WAGNER HEIGHTS RESIDENTIALFACILITY NUMBER:
392700306
ADMINISTRATOR:MANISHA PUNNIFACILITY TYPE:
740
ADDRESS:2435 WAGNER HEIGHTS RDTELEPHONE:
(209) 477-5353
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:80CENSUS: 52DATE:
06/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Manisha Punni TIME COMPLETED:
02:15 PM
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On 6/23/23 at approximately 1:45pm Licensing Program Analyst (LPA) Jennifer Fain and Licensing Program Manager (LPM) Liza King conducted a case management visit to the facility for the purpose of delivering an Order To Individual of Immediate Exclusion from all facilities and the Order to Licensee/Facility of Immediate Exclusion From Facility. LPA Fain and LPM King met with Administrator Manisha Punni, LPA explained the purpose of today's visit. Staff (S-1) excluded as a result not related to this facility.
LPA Fain and LPM King handed the Order to Licensee/Facility of Immediate Exclusion From Facility letter to Administrator and explained that staff must leave the facility immediately.

LPA handed the Order To Individual of Immediate Exclusion from all facilities to staff and explained that they needed to leave the facility immediately.

No citations were issued on today's date. A copy of the report was provided to Administration.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Jennifer FainTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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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