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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700752
Report Date: 05/03/2023
Date Signed: 09/14/2023 11:58:53 AM

Document Has Been Signed on 09/14/2023 11:58 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
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: 46DATE:
05/03/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Multiple parties and agenciesTIME COMPLETED:
12:15 PM
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A Non-Compliance Conference was held via Microsoft Teams with Licensee and/or Licensee Representative of GOD'S LOVE OUTREACH MINISTRIES (G.L.O.M) on 05/03/2023 to discuss the recently identified concerns associated with the operation of all facilities licensed by CCLD to GOD'S LOVE OUTREACH MINISTRIES (G.L.O.M).

The following facilities are subject to the compliance review during this Non- Compliance Conference:

Sacramento South RO:
· G.L.O.M A.R.F. 3 392700629
· G.L.O.M A.R.F. 4 392700627
· G.L.O.M A.R.F. 5 392700628
· G.L.O.M A.R.F. 6 392700752*

Fresno RO:
· G.L.O.M A.R.F 7 247209077*
· G.L.O.M.A.R.F. 9 247209075*
· G.L.O.M.A.R.F. 10 247209076*

Oakland RO:
· G.L.O.M. ARF 019200678
· G.L.O.M. ARF 2 019200842
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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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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: G.L.O.M. A.R.F. 6
FACILITY NUMBER: 392700752
VISIT DATE: 05/03/2023
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Bruce Shepard, Licensee Representative
Lisa Evans, Licensee Representative
Jake Reinhardt Licensee Legal Counsel/ Representative

Jacqueline Juarez, Supervising Governmental Auditor I with Audit Section
Jorge Mojica, General Auditor III with Audit Section

Isaac Taggart, Licensing Program Manager II with Oakland RO
Stephenie Doub, Licensing Program Manager II with Sacramento South RO
Brenda White, Licensing Program Manager II with Fresno RO

Emerita Curiel, Licensing Program Manager I with Sacramento South RO
Liza King, Licensing Program Manager I with Sacramento South RO
Harpreet, Humpal, Licensing Program Manager I with Oakland RO
Sergiy Pidgirny, Licensing Program Manager I with Fresno RO
Brenda Chan, Licensing Program Manager I with Fresno RO

Renee Campbell Licensing Program Analyst with Sacramento South RO
Albert Johnson Licensing Program Analyst with Sacramento South RO
Grace Luk, Licensing Program Analyst with Oakland RO
Melinda Medina, Licensing Program Analyst with Fresno RO

Representatives from Stanislaus, San Joaquin and Merced Counties.
Representatives from Department of Healthcare Services (DHCS).

Donna Bickham, San Joaquin Behavioral Health (SJBH)
Alicia Tacata, SJBHS
Valentine Genevieve, SJBHS
Maureen Cooper, DHCS
Whitney Hart, DHCS
Kit Chang, Merced County
Thomas E. Ebersole,
Adrian Angel,
Nicole Bettencourt Merced County
Oliva Delayne Stanislaus Behavioral Health
Sharon Jones
Manjit Kaur Merced County
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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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: G.L.O.M. A.R.F. 6
FACILITY NUMBER: 392700752
VISIT DATE: 05/03/2023
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CCLD compliance concerns are as follows:

· Audit compliance and audit findings by the CCLD Audit Section.
· Conduct Inimical. Involvement in any capacity of the previously excluded individual in the general operation of the facilities licensed to GOD'S LOVE OUTREACH MINISTRIES (G.L.O.M)
· Conduct Inimical. Presence in any capacity of the previously excluded individual on the premises of the facilities licensed to GOD'S LOVE OUTREACH MINISTRIES (G.L.O.M).
· Licensing fees/ Delinquency. *Licensing fees are not current as of 04/10/2023.

· Advertising and license number.



Exit interview conducted with:

Bruce Shepard,Licensee Representative
Lisa Evans, Licensee Representative
Jake Reinhardt, Licensee Legal Counsel/ Representative
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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