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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701185
Report Date: 07/03/2024
Date Signed: 07/03/2024 12:44:48 PM

Document Has Been Signed on 07/03/2024 12:44 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:COOKS CARE RESIDENTIAL FACILITY #2FACILITY NUMBER:
392701185
ADMINISTRATOR/
DIRECTOR:
COOKS, MICHAELFACILITY TYPE:
735
ADDRESS:2419 CLARIDGE LNTELEPHONE:
(209) 817-4860
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 4CENSUS: 2DATE:
07/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Michael CooksTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 7-3-24 at 12:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding an incident reported on 6-21-24. LPA met with Administrator Michael Cooks and explained the purpose of the visit. LPA reviewed incident report and conducted brief interviews with Administrator and resident1 (R1). Based on record review and interview it was reported that on 6-20-24 at approximately 9:46am, Administrator was notified by R1's family member that R1 had contacted step dad to inform that another resident "raped" him. At 10:45am, local law enforcement arrived to take a statement at which time, based on record review and interviews conducted, it was determined that R1 made a false statement and declared that the alleged event did not occur. Administrator reported incident appropriately within regulatory time frames. R1's individualized program plan (IPP) has been updated accordingly.

As a result of today's case management, no citations are issued. An exit interview was conducted with Administrator and a copy of this report was provided to Administrator.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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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