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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
392700997
Report Date:
06/23/2021
Date Signed:
06/24/2021 01:29:04 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:
CAMLU ASSISTED LIVING
FACILITY NUMBER:
392700997
ADMINISTRATOR:
WHITTED, ALMA
FACILITY TYPE:
740
ADDRESS:
6037 N. PERSHING AVENUE
TELEPHONE:
(209) 951-2030
CITY:
STOCKTON
STATE:
CA
ZIP CODE:
95207
CAPACITY:
160
CENSUS:
60
DATE:
06/23/2021
TYPE OF VISIT:
Case Management - Legal/Non-compliance
UNANNOUNCED
TIME BEGAN:
11:30 AM
MET WITH:
NA
TIME COMPLETED:
02:45 PM
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On 06/23/2021 at 11:30am, Licensing Program Analyst (LPA) Ashley Boothe created this report in error.
No Legal/Non-compliance visit was conducted at this facility on this date.
SUPERVISOR'S NAME:
Liza King
TELEPHONE:
(916) 263-4752
LICENSING EVALUATOR NAME:
Ashley Boothe
TELEPHONE:
(916) 708-7751
LICENSING EVALUATOR SIGNATURE:
DATE:
06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/23/2021
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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