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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700993
Report Date: 12/21/2021
Date Signed: 12/21/2021 01:02:45 PM

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:A1 DEL MONTE STOCKTONFACILITY NUMBER:
392700993
ADMINISTRATOR:SAINI, ANURADHAFACILITY TYPE:
740
ADDRESS:517 E. FULTON STREETTELEPHONE:
(209) 910-5910
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:158CENSUS: 96DATE:
12/21/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Jenna SilvaTIME COMPLETED:
01:05 PM
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On 12-21-21 at 12:35pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit related to a previously issued citation on 12-9-21 for complaint #27-AS-20211116124932. LPA met with Jenna Silva and explained the purpose of the visit. Anuradha Saini was notified via phone of LPA's visit and gave permission for Jenna to accommodate and sign paperwork in her absence. The citation previously issued on 12-9-21 has been amended to update the Title 22 regulation number #87411(a). As a result, the previously issued civil penalty has been removed.

An exit interview was conducted with Jenna Silva and a copy of this report was left with Jenna. Appeal Rights provided.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
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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