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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700306
Report Date: 07/08/2024
Date Signed: 07/08/2024 11:11:32 AM


Document Has Been Signed on 07/08/2024 11:11 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: DATE:
07/08/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Multiple TIME COMPLETED:
11:00 AM
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A Non-Compliance Conference (NCC) follow up was conducted on this day in the Sacramento South Regional Office via Microsoft Teams. The purpose of this Non-Compliance Conference meeting was to follow up on a previous citation issued to facility . Present in the meeting was Regional Manager (RM) Stephanie Doub, Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Kesha Lewis, and Licensee reprecintive Rosalie Sullivan, Administrator Manisha Punni. The Non-Compliance Conference process was explained during this meeting to include the Administrative Process.

Topics in this meeting included the following: (1) Care and Supervision, (2) Medication Logging and signing and Maintenance and Operation, also the improvement from the facility regarding the above topics. The facility was able to maintain substantial compliance over the last 12 months therefore the department will stop quarterly visits at this time.

Exit interview and copy of report provided.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (916) 764-1024
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2024
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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