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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700366
Report Date: 05/11/2022
Date Signed: 05/13/2022 01:44:14 PM


Document Has Been Signed on 05/13/2022 01:44 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:COMMONS AT UNION RANCH, THEFACILITY NUMBER:
392700366
ADMINISTRATOR:DIANA BORZAFACILITY TYPE:
740
ADDRESS:2241 N UNION ROADTELEPHONE:
(209) 463-9100
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:135CENSUS: 95DATE:
05/11/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Karen SilvaTIME COMPLETED:
04:00 PM
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Unannounced plan of correction visit made out to this facility on 05/11/2022 by Licensing Program Analysts (LPAs) Charlie Yang and Arielle Pascua who were met by the facility designated Administrator Karen Silva. Brief interview was conducted with the facility designated Administrator.
The purpose of this visit was to clear the deficiencies that were cited on several complaints that were filed with this office. These complaints were filed on 01/14/2022, 01/12/2022, 12/20/2021, and 11/18/2021.
Plan of correction letters were generated and a copy was given to the facility designated Administrator Karen Silva at this time.

Exit Interview
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022
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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