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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700451
Report Date: 10/21/2021
Date Signed: 10/21/2021 01:39:34 PM

Document Has Been Signed on 10/21/2021 01:39 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:CHESNEY PROFESSIONAL CAREFACILITY NUMBER:
392700451
ADMINISTRATOR:CHESNEY, CHRISFACILITY TYPE:
735
ADDRESS:7163 UYEDA RDTELEPHONE:
(209) 403-8948
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY: 15CENSUS: 11DATE:
10/21/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Stan and Chris ChesneyTIME COMPLETED:
01:45 PM
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On 10/21/2021 at 12:35pm, Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a case management visit to clear POC's cited on 9/1/2021 during Required- 1 Year annual inspection. LPA met with Administrator and was allowed entry into the facility, today's census is 11.

LPA observed POC for deficiency cited under Title 22 80087(a) has been completed by extended POC due date.

POC letter generated and provided during today's visit.

Per the California Code of Regulations, Title 22, no deficiencies observed or cited. Exit interview held and a copy of report provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Ashley Boothe
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2021
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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