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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397000014
Report Date: 12/10/2024
Date Signed: 12/11/2024 09:20:38 AM

Document Has Been Signed on 12/11/2024 09:20 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:BRISBANE'S GUEST HOMEFACILITY NUMBER:
397000014
ADMINISTRATOR/
DIRECTOR:		GAPASIN, ESTELAFACILITY TYPE:
735
ADDRESS:9512 BRISBANE PLACETELEPHONE:
(209) 952-9818
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 6CENSUS: 5DATE:
12/10/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Gregoria BalTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 12-10-2024, Licensing Program Analysts (LPA) Kesha Lewis conducted an unannounced facility visit to check that the order of allegation notice (Declaration of service) was posted in a public place in the facility. LPA Lewis met with staff and explained the purpose of today's visit.


LPA Lewis could not locate the notice and staff stated it was in the mail area but was gone now that Esther must had taken it.

LPA Lewis informed them that the notice was to be posted in a public place. LPA also notified staff and licensee via phone that another correspondence has been sent from the department.

The Licensee returned from out of the country on November 26th 2024.


An exit interview was conducted, and a copy of this report was given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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