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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700665
Report Date: 08/07/2024
Date Signed: 08/09/2024 08:31:15 AM

Document Has Been Signed on 08/09/2024 08:31 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LAV MANORFACILITY NUMBER:
392700665
ADMINISTRATOR/
DIRECTOR:		JOYCE VILLANUEVAFACILITY TYPE:
735
ADDRESS:6411 KERMIT LANETELEPHONE:
(209) 473-4250
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 6CENSUS: 3DATE:
08/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Corazon AndresTIME VISIT/
INSPECTION COMPLETED:
03:09 PM
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On 8/7/2024, Licensing Program Analyst (LPA) Albert Johnson conducted a health and safety check. LPA met with Corazon Andres.

Health and Safety check included food supply, physical plant and staffing. based on this inspection/visit the facility is in compliance.

The administrator will be on vacation July 17th - August 18th and has attached an LIC 308 form to designate Lorna Villanueva as acting Administrator for LAV Manor. Lorna Villanueva is also the Licensee of LAV Manor and has a current Administrator License. Lorna has Covid and was unable to attend the meeting today.

No deficiencies were cited pursuant to Title 22 rules and regulations, Health and Safety Code
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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