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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700366
Report Date: 03/24/2025
Date Signed: 03/25/2025 09:12:23 AM

Document Has Been Signed on 03/25/2025 09:12 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:COMMONS AT UNION RANCH, THEFACILITY NUMBER:
392700366
ADMINISTRATOR/
DIRECTOR:		SHERYL BRAVOFACILITY TYPE:
740
ADDRESS:2241 N UNION ROADTELEPHONE:
(209) 463-9100
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY: 135TOTAL ENROLLED CHILDREN: 0CENSUS: 107DATE:
03/24/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Sheryl BravoTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Unannounced case management visit made out to this facility on 03/24/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Sheryl Bravo, and was briefly interviewed at this time.
Current census was 107 residents.
The purpose of today's case management visit was to follow up on several incidents, including death reports, that were recently submitted into CCL.
The following LIC 624s were reviewed and discussed for the following residents that were in care:
  • R1
  • R2


It was learned that the above referenced residents(R1 and R2) were under the care of a hospice agency prior to passing away at this facility.
It was learned that the hospice agencies were present and responsible family and friends were made aware of the situation and passing of the resident.

There were no deficiencies observed or cited during today's case management visit.

Exit Interview
Liza KingTELEPHONE: (650) 676-0442
Charlie YangTELEPHONE: (916) 709-6507
DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2025
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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