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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700752
Report Date: 08/09/2022
Date Signed: 08/09/2022 01:47:27 PM

Document Has Been Signed on 08/09/2022 01:47 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. 6FACILITY NUMBER:
392700752
ADMINISTRATOR:ANTHONY ISBELLFACILITY TYPE:
735
ADDRESS:404-408 E. PINE STTELEPHONE:
(209) 330-7155
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 46CENSUS: DATE:
08/09/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lisa EvansTIME COMPLETED:
01:43 PM
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On 8-9-22 at 1:00pm, a non-compliance conference was held to discuss a previous accusation and document regarding a criminal record exemption dated 4-16-21. Present at this meeting were Liza King, Licensing Program Manager (LPM), Stephanie Doub, LPM, Michael Bilger, Licensing Program Analyst (LPA), Renee Campbell, LPA and Lisa Evans, Board Secretary for God’s Love Outreach Ministries (G.L.O.M) (Licensee). This meeting was held virtually via Microsoft Teams Meeting.

The purpose of this meeting was to discuss the document noted above and a recent citation issued on 5-5-22 regarding excluded individual present in facility. The accusation and criminal record exemption denial document dated 4-16-21 was read by LPM and LPA verbatim to Board Secretary. Board Secretary stated her acknowledgment of understanding and commitment to compliance as well as commitment to educate current and future facility staff of importance to compliance with this matter. Board Secretary made aware that any further non-compliance may result in actions taken by the Department which may include but not be limited to: Administrator decertification and license revocation.

A copy of this report was read via phone to Lisa Evans and a copy of this report was sent to Lisa via email with request for return with signature.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2022
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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