<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700879
Report Date: 12/28/2022
Date Signed: 12/29/2022 01:24:18 PM

Document Has Been Signed on 12/29/2022 01:24 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
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ARVEAH'S CARE HOMES, LLCFACILITY NUMBER:
392700879
ADMINISTRATOR:DAVIS, ARVINFACILITY TYPE:
735
ADDRESS:2502 ALEXA WAYTELEPHONE:
(650) 219-3369
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 6CENSUS: 0DATE:
12/28/2022
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Arvin DavisTIME COMPLETED:
02:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
“Licensing Program Analyst (LPA) Kesha Lewis made an announced visit on this day at approximately 1:00pm for the purpose of conducting an abbreviated annual inspection. An annual inspection was previously conducted on 11/07/2022.

LPA Lewis met with Arvin Davis, observed the following
· Covid precautions being followed
· Interior and exterior of the plant
· Medications were observed to have a place to be locked up
· Fire extinguisher fully charged.
· Smoke detectors all operational.
· Hot water temperature measured 110 degrees.

There are no Health and Safety concerns at this time. Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was emailed to Arvin Davis”.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2022
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 1