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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701487
Report Date: 02/28/2025
Date Signed: 02/28/2025 10:12:18 AM

Document Has Been Signed on 02/28/2025 10:12 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:NZJ CARE LLCFACILITY NUMBER:
392701487
ADMINISTRATOR/
DIRECTOR:		JOAO, PAULINA K TECAFACILITY TYPE:
735
ADDRESS:8920 MOUNT EDDY CTTELEPHONE:
(209) 594-8150
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 4CENSUS: 0DATE:
02/28/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:JOAO, PAULINATIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 2/28/2025, Licensing Program Analyst (LPA) Kesha Lewis arrived announced to conduct a Pre-Licensing visit. to check that the licensee had moved out of the facility. and check that the required repairs had been completed. LPA was greeted by applicants JOAO, PAULINA K TECA and explained the purpose of the visit.

This facility will be licensed to hold 4 residents, of which 4 may be ambulatory. This facility is also awaiting vendorization from Valley Mountain Regional Center and will accept and hold Level 4I residents.

Comp III was completed during last visit on 01/29/2025. Facility is ready to be licensed.

Exit interview conducted, and copy or report given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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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