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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002540
Report Date: 02/16/2024
Date Signed: 02/16/2024 10:46:41 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/16/2024 10:46 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:VILLA TERESA 1 CARE HOMEFACILITY NUMBER:
397002540
ADMINISTRATOR:JUSTIN JOSEFACILITY TYPE:
740
ADDRESS:2477 CARPENTER ROADTELEPHONE:
(209) 462-4239
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 6CENSUS: 4DATE:
02/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Administrator not presentTIME COMPLETED:
11:00 AM
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On 2-16-24 at 10:22am, Licensing Program Analyst (LPA) Michael Bilger arrived at facility unannounced to conduct an annual inspection. LPA knocked on the door and rang bell; waiting for 15 minutes. LPA called facility and spoke with facility staff who was at another location and informed LPA all clients were in day program. LPA called and spoke with Administrator Justin Jose, who confirmed all resident were in day program and was away from facility for extended time due to a previously scheduled appointment.

LPA was unable to complete this annual inspection as a result. LPA will re-attempt visit at a later date.

No citation issued today. An exit interview was conducted with Justin Jose via phone and a copy of this report was mailed to Justin with a request for return with signature.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2024
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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