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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701106
Report Date: 04/04/2023
Date Signed: 06/09/2023 01:59:58 PM

Document Has Been Signed on 06/09/2023 01:59 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:LA FAMILIA RESIDENCE 2 INC.FACILITY NUMBER:
392701106
ADMINISTRATOR:YEPIZ, GUADALUPE CRYSTALFACILITY TYPE:
735
ADDRESS:570 SANDPIPER CIRTELEPHONE:
(209) 331-9417
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 6CENSUS: 6DATE:
04/04/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Guadalupe Yepiz , Administrator TIME COMPLETED:
12:00 PM
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On 04/04/2023, Licensing Program Analyst (LPA) Renee Campbell visited facility at approximately 9 am. LPA met with Administrator Guadalupe Crystal Yepiz and explained the purpose of the visit. The case management was to follow up on an incident report that was reported to the LPA regarding R1's disruptive behavior potentially regarding an allegation of sexual abuse by a family member that did not occur in the facility.

During the visit, LPA interviewed R1 and the Administrator to obtain additional information . LPA Campbell spoke with R1 and administrator regarding the resident's behavior to determine what plans are being implemented to help resident. In the meantime, the facility is providing the support that is needed. LPA advised the facility to work with the regional center for next steps. Administrator also mentioned to LPA about the potential restraining order being put in place due to the harassment from a family member to the facility.

No deficiencies issued during today's visit.

Exit interview conducted with the administrator and a copy of this report was provided.

SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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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