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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700473
Report Date: 08/18/2022
Date Signed: 08/19/2022 09:59:51 AM


Document Has Been Signed on 08/19/2022 09:59 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:MANTECA RTRMT COM-HAPPY LVNG BY COGIR/COGIR MANTECFACILITY NUMBER:
392700473
ADMINISTRATOR:SHERYL BRAVOFACILITY TYPE:
740
ADDRESS:430 NORTH UNION RDTELEPHONE:
(209) 823-0164
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY:84CENSUS: 56DATE:
08/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sheryl BravoTIME COMPLETED:
03:30 PM
NARRATIVE
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Unannounced plan of correction visit made out to this facility on 08/18/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Sheryl Bravo who was briefly interviewed.
Current census was 56 residents.
The purpose of this visit was to review the plan of corrections that were due from prior annual visit that was conducted on 08/04/2022.

Facility designated personnel stated that a work order will be commissioned and the fallen fence sections of the perimeter will be replaced/repaired as needed. A statement of correction, along with a copy of the work order and photos of the updated fence, will be completed and submitted into CCL by the due date.

Facility designated personnel stated that a work order will be commissioned and the window screens will be replaced/repaired as needed. A statement of correction, along with a copy of the work order, will be completed and submitted into CCL by the due date.

Brief tour of the facility exterior grounds was conducted. LPA observed that the window screens had been replaced and in compliance at this time. This LPA observed that a work order had been put in place to repair/replace the facility perimeter fence next to the apartment complex.

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

Exit Interview
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 709-6507
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2022
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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