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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700629
Report Date: 04/28/2022
Date Signed: 04/28/2022 02:25:46 PM

Document Has Been Signed on 04/28/2022 02:25 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:G.L.O.M. A.R.F. 3FACILITY NUMBER:
392700629
ADMINISTRATOR:ALEXANDRA ARCHANGELFACILITY TYPE:
772
ADDRESS:1117 SOUTH GRANT STREETTELEPHONE:
(209) 330-7155
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 15CENSUS: DATE:
04/28/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lisa EvansTIME COMPLETED:
02:00 PM
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An office meeting was held with representatives from the facility, Lisa Evan and Jessica Turner. Present for the Department were Regional Manager Krystall Moore, Licensing Program Manager Liza King and Licensing Program Analyst Bruce Jacobs. The purpose of the meeting was to discuss the appeal of citations given to the facility. They were advised the appeal decision will be mailed in a few days.

In addition, facility operations were discussed as well as applications for new facilities in the region. Regional Manager Krystall reminded the facility to ensure that excluded individuals do not have contact with staff and residents at the facility or act on behalf of the corporation. Due dates for Plans of Corrections were also discussed.

A copy of this report was provided at the conclusion of the meeting.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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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