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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700436
Report Date: 07/01/2022
Date Signed: 07/01/2022 10:25:49 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/01/2022 10:25 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:GM ARF 2FACILITY NUMBER:
392700436
ADMINISTRATOR:MATA, CESAR YFACILITY TYPE:
735
ADDRESS:2423 COURTNEY WAYTELEPHONE:
(916) 706-8427
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 4CENSUS: 0DATE:
07/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Administrator not presentTIME COMPLETED:
10:30 AM
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On 7-1-22 at 10:01am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct an annual inspection. Upon arrival LPA rang door bell with no answer after 5 minutes. At 10:06am, LPA attempted to call Administrator at (916) 706-8427 but did not receive an option to leave a voicemail. LPA sent Administrator an email at GMARFLLC2018@YAHOO.COM informing Administrator of LPA's attempted visit. LPA observed blinds closed and curtains closed with lights off.

No deficiencies cited today. A copy of this report will be kept on file. Administrator or designee unable to sign due to absence.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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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