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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700747
Report Date: 05/04/2023
Date Signed: 05/04/2023 12:16:15 PM

Document Has Been Signed on 05/04/2023 12:16 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:VEA'S CARE HOMEFACILITY NUMBER:
392700747
ADMINISTRATOR:FHARELL, MICHAELFACILITY TYPE:
735
ADDRESS:2232 S SACRAMENTO STTELEPHONE:
(209) 662-5783
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 6CENSUS: 4DATE:
05/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Josie VeaTIME COMPLETED:
12:08 PM
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LPA Albert Johnson made an unannounced POC visit to the facility to verify correction of living arrangements for the staff at the facility.

The Licensee has cleared out the area used to have staff sleep. The facility will request the City of Stockton for permits to complete or convert the garage into a staff room. LPA informed the staff that the permits along with a LIC 200 form with a new fire clearance inspection will be required.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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