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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700644
Report Date: 11/29/2021
Date Signed: 11/30/2021 08:55:03 AM

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:SOMERFORD PLACE - STOCKTONFACILITY NUMBER:
392700644
ADMINISTRATOR:ANDERSON, LESLIEFACILITY TYPE:
740
ADDRESS:3530 DEER PARK DRIVETELEPHONE:
(209) 951-6500
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:60CENSUS: 39DATE:
11/29/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Multiple partiesTIME COMPLETED:
02:30 PM
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An Office meeting conference was conducted today via teleconference by the Sacramento South Regional Office. The purpose of this meeting was to discuss the facility's change of name and new management operations.

Present in the meeting were Regional Managers (RM) Krystall Moore ( Sacramento South), RM Leslie Mendiveles ( San Bernardino) and RM Brenda White (Fresno), Licensing Program Managers, Stephen Richardson ( Sacramento South) Czarrina Camilon Lee ( Sacramento South) and John Rante ( San Diego), Licensing Program Analyst Albert Johnson ( Sacramento South), NorthStar representatives Steve Kregel, Evelyn Mendez- Choy, Brook Lowther and Scott Putnam, Administrator Leslie Anderson, and SNH representatives Jennifer Francis, Jacquelyn Anderson, Kristin Gowdy and Centralized Application Bureau representatives Hao Nguyen, Tracy Thompson and Jude De la Concepcion.

The purpose of the meeting was to discuss Northstar operational/management of the facilities owned by SNH Statewide.

Continued
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SOMERFORD PLACE - STOCKTON
FACILITY NUMBER: 392700644
VISIT DATE: 11/29/2021
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Issues discussed during the meeting were:

· Administrative Organization
· Change of Ownership/management company (CHOM)
· New Application

The Licensee will do the following:

· Licensee submitted an abbreviated application to add the management company today 11/29/21.
· Northstar will not assume operational control of the facilities until the applications are approved.
· SNH understands that they will remain responsible for facility until the change of management is approved.
· Licensee will consult with Northstar until a new Management company is approved and SNH will hire/appoint Executive Directors at all facilities until the CHOM is approved.

LPA provided a copy of this report with appeal rights.

SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC809 (FAS) - (06/04)
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