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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701318
Report Date: 04/02/2025
Date Signed: 04/02/2025 04:20:56 PM

Document Has Been Signed on 04/02/2025 04:20 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: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: 5DATE:
04/02/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Administrator Christopher WaltersTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On 4/2/25, at 4PM, Licensing Program Analysts(LPAs) Noel Wolf Petersen and Michael Bilger made a case management visit for an significant incident report involving a physical altercation between two of his residents. On 3/17/25, one resident arrived from school and continued an ongoing argument with the second resident, the second resident escalated the conflict by throwing an object and physically attacking resident one. The staff intervened and stopped the physical fighting, when resident two expressed a self injurious behavior and the staff again intervened to contain the damage. Resident two needed some minor first aid, resident one was not requiring aid. While the administrator contacted the Regional Center, Police, and Ombudsman. LPA's explained the purpose of the visit to the administrator, the LPA's talked to staff and reviewed client files regarding the incident until the relevant residents arrived form their day program. After the residents arrived, the LPA's interviewed them and concluded the case management.

No citation was given to the administrator, and then a copy of this report was read and delivered to the administrator.
NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Noel Wolf Petersen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2025
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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