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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701060
Report Date: 09/12/2023
Date Signed: 09/12/2023 11:37:06 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/12/2023 11:37 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:SV RESIDENTIAL FACILITY 2FACILITY NUMBER:
392701060
ADMINISTRATOR:YADAO, VIRGINIA ARRUBIOFACILITY TYPE:
740
ADDRESS:516 TULE SPRING STREETTELEPHONE:
(209) 915-9955
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:4CENSUS: 0DATE:
09/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Licensee not presentTIME COMPLETED:
11:10 AM
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On 9-12-23 at 10:39am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced at facility to conduct a annual inspection. LPA arrived and rang doorbell with no response after 10 minutes. LPA called Licensee but unable to connect; LPA left message. LPA observed blinds closed and lights off in the facility.

As a result of today's visit, today's annual was unable to be completed. LPA will return at a later time to complete annual. A copy of this report will be mailed to licensee with request for return with signature. Licensee unable to sign today due to absence.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
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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