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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700368
Report Date: 03/08/2022
Date Signed: 03/08/2022 04:08:08 PM


Document Has Been Signed on 03/08/2022 04:08 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 ON THORNTON, THEFACILITY NUMBER:
392700368
ADMINISTRATOR:MILLER, CAROLFACILITY TYPE:
740
ADDRESS:10711 THORNTON RDTELEPHONE:
(209) 476-1500
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:110CENSUS: DATE:
03/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Marie Arbios, Executive DirectorTIME COMPLETED:
04:20 PM
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Licensing Program Analyst Bruce Jacobs conducted a case management visit in regards to a reported change in the Executive Director Facility Administrator position. LPA met with new Facility Administrator Marie Arbios and requested the following documentation due to the Department by close of business on March 16th, 20022.

For Administrator changes, the Regional Office is requesting the following:

* A letter from the licensee and/or Board appointing the individual as the Administrator .
* LIC 200 signed by the licensee or designee.
* LIC 500 to indicate the days/hours the administrator is in the facility.

A copy of the Administrator Certification and LIC 308 and LIC 501 has been received by LPA. It was reported that appointed individual is fingerprinted and associated to the facility, to be verified by LPA,

No deficiencies were identified on this visit and report provided to Executive Director Marie Arbios.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce JacobsTELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
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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