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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397001458
Report Date: 09/25/2024
Date Signed: 09/25/2024 08:46:21 AM

Document Has Been Signed on 09/25/2024 08:46 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:TACSION'S GUEST HOME #3FACILITY NUMBER:
397001458
ADMINISTRATOR/
DIRECTOR:		TACSION, ROBERTFACILITY TYPE:
735
ADDRESS:2344 WAGNER HEIGHTSTELEPHONE:
(209) 952-6037
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 6CENSUS: 5DATE:
09/25/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Vilma Deleon TIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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On 9/25/2024, LPA Kesha Lewis made an unannounced visit on this date to conduct a health and safety check. LPA met with staff Vilma Deleon.

The temperature in the facility was a comfortable 77 degrees in the main area facility is clean and sanitary.

Staff state that R1 only stayed one night and then the resident was taken to another facility on 9/24/2024 around 2:30 PM.



Exit interview and copy of report given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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