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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701318
Report Date: 10/01/2024
Date Signed: 10/01/2024 10:36:16 AM

Document Has Been Signed on 10/01/2024 10:36 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:ESTEEMED RESIDENTIAL CARE 2FACILITY NUMBER:
392701318
ADMINISTRATOR/
DIRECTOR:		WALTERS, CHRISTOPHERFACILITY TYPE:
735
ADDRESS:2431 ETCHEVERRY DRIVETELEPHONE:
(925) 219-2787
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 4CENSUS: 4DATE:
10/01/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Jonathan Burgess TIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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Post licensing was completed during the annual visit see LIC 809-10/01/2024.

There were no deficiencies observed or cited during today's post licensing visit.



Exit interview and copy of report given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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