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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
392701110
Report Date:
09/06/2022
Date Signed:
09/15/2022 04:50:23 PM
Document Has Been Signed on
09/15/2022 04:50 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
CCLD Regional Office
,
2525 NATOMAS PARK DR. STE.270
SACRAMENTO
,
CA
95833
FACILITY NAME:
LIFE PATHWAY VOCATIONAL DEVELOPMENT CENTER
FACILITY NUMBER:
392701110
ADMINISTRATOR:
ENUNWA, JOHN
FACILITY TYPE:
775
ADDRESS:
9305 THORNTON ROAD SUITE E
TELEPHONE:
(310) 953-1378
CITY:
STOCKTON
STATE:
CA
ZIP CODE:
95209
CAPACITY:
30
CENSUS:
DATE:
09/06/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:14 AM
MET WITH:
TIME COMPLETED:
10:15 AM
NARRATIVE
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Attempted visit, waiting for VMRC to approve the program plan
SUPERVISORS NAME
:
Stephenie Doub
LICENSING EVALUATOR NAME
:
Albert Johnson
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/06/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/06/2022
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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