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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701210
Report Date: 12/22/2022
Date Signed: 12/22/2022 11:19:03 AM

Document Has Been Signed on 12/22/2022 11:19 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:YADAO'S TENDER CARE HOMEFACILITY NUMBER:
392701210
ADMINISTRATOR:MELEGRITO, KARRENFACILITY TYPE:
735
ADDRESS:8129 LORRAINE AVENUETELEPHONE:
(209) 954-8251
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 4CENSUS: 0DATE:
12/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marie YadaoTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Kesha Lewis and Licensing Program Manager (LPM) LIza King made an announced visit to the facility to conduct a pre-licensing visit on 12/22/2022 LPA Lewis and LPM King identified Them self and discussed the purpose of the visit with licensees and administrator.

The facility has a fire clearance for a capacity of 4 (2 ambulatory , 2 non-ambulatory and 2 bedridden residents). LPA observed there are no residents at this time.



LPA Lewis and LPM King inspected the interior and exterior of the facility. At this time, the pre-licensing visit is complete. The applicant has passed the pre-licensing component of the application process today.

An exit interview was conducted and a copy of this report was left at the facility.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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