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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
392701435
Report Date:
12/11/2024
Date Signed:
12/11/2024 02:59:17 PM
Document Has Been Signed on
12/11/2024 02:59 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:
DE TRIO FOUNDATION
FACILITY NUMBER:
392701435
ADMINISTRATOR/
DIRECTOR:
BONNER JR, WILLIAM A
FACILITY TYPE:
735
ADDRESS:
401 W. POPLAR ST
TELEPHONE:
(209) 639-5134
CITY:
STOCKTON
STATE:
CA
ZIP CODE:
95203
CAPACITY:
4
CENSUS:
0
DATE:
12/11/2024
TYPE OF VISIT:
Prelicensing
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:53 AM
MET WITH:
Bonner
TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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This is a continued pre- licensing inspection to confirm the completion of the advisories which needed to be completed by 12/ 9/2024.
The facility completed the required advisories and has passed the pre-licensing component of the application process. LPA Johnson will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed.
Exit interview conducted.
SUPERVISORS NAME
:
Lisa Rios
LICENSING EVALUATOR NAME
:
Albert Johnson
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/11/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/11/2024
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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