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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701185
Report Date: 09/26/2024
Date Signed: 09/27/2024 09:31:52 AM

Document Has Been Signed on 09/27/2024 09:31 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
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: 4DATE:
09/26/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:M. CooksTIME VISIT/
INSPECTION COMPLETED:
02:58 PM
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Licensing Program Analyst (LPA) Albert Johnson conducted a health and safety check on this day. LPA met with Administrator.

The current residents that have been relocated are adjusting to the new environment. Today's Health and Safety check included food supply, physical plant and staffing. Based on this inspection/visit the facility is in compliance.

The residents have their belongings, medications and are transitioning.

No deficiencies were cited pursuant to Title 22 rules and regulations, Health and Safety Codes.

Exit interview conducted.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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