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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397001983
Report Date: 10/17/2022
Date Signed: 11/02/2022 10:07:20 AM

Document Has Been Signed on 11/02/2022 10:07 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:NEW HOPE GUEST HOME-BALBOAFACILITY NUMBER:
397001983
ADMINISTRATOR:FELIX, ROBERT A.FACILITY TYPE:
735
ADDRESS:8343 BALBOA AVENUETELEPHONE:
(209) 478-8010
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 6CENSUS: 0DATE:
10/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Bob Felix TIME COMPLETED:
11:30 AM
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Licensing Program Analyst's (LPA'S) Kesha Lewis and Albert Johnson conducted an unannounced case management visit to the facility on 10/17/2022 to follow up on an incident that occurred on 10/15/22.

LPA'S walked through facility and took pictures of fire damage during today's visit, LPA'S spoke with licensee. Licensee provided list of all other locations residents had been moved too. Licensee states all other facilities are within capacity.

This case management needs no further investigation. Licensee will email LPA updates about cleanup, expected move in date and when facility is back up and running.

Exit interview was conducted with Staff. An electronic copy of the report was emailed to the facility to obtain a signature from the Licensee and emailed back to LPA to be filed.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2022
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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