<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
392700885
Report Date:
11/14/2024
Date Signed:
12/05/2024 10:34:31 PM
Document Has Been Signed on
12/05/2024 10:34 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 SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
DELTA AT THE PORTSIDE
FACILITY NUMBER:
392700885
ADMINISTRATOR/
DIRECTOR:
TANYA MONGE
FACILITY TYPE:
740
ADDRESS:
1950 E SONORA STREET
TELEPHONE:
(209) 689-3180
CITY:
STOCKTON
STATE:
CA
ZIP CODE:
95205
CAPACITY:
66
CENSUS:
46
DATE:
11/14/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
12:54 PM
MET WITH:
Momo Doua
TIME VISIT/
INSPECTION COMPLETED:
02:00 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) Albert Johnson arrived at the facility unannounced to conduct a case management visit. LPA met with Staff and explained the purpose of the visit. Later joined by Momo Duoa.
The facility has submitted the required information to appoint a new Administrator. The department reviewed the record of pending applications and confirmed that the information has been submitted to renew the certification of the appointed Administrator.
No further action required.
SUPERVISORS NAME
:
Lisa Rios
LICENSING EVALUATOR NAME
:
Albert Johnson
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/14/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/14/2024
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