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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002682
Report Date: 09/22/2021
Date Signed: 09/22/2021 03:31:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SUNNY PLACE OF STOCKTONFACILITY NUMBER:
397002682
ADMINISTRATOR:EXPECTACIO VIERRAFACILITY TYPE:
740
ADDRESS:807 WEST SWAIN ROADTELEPHONE:
(209) 956-8677
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:18CENSUS: 12DATE:
09/22/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Melody BanalTIME COMPLETED:
03:40 PM
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On 09/22/2021 at 2:00pm, Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a case management visit on an incident report submitted to the Department and explained the purpose of today’s visit. LPA was allowed entry into the facility and met with Designated staff (S1) and Administrator was unable to be present during today's visit. Census 12.

On 9/20/2021 LPA received incident report for Resident one (R1) moving out the facility. LPA conducted interviews and requested records. At this time additional information is needed. LPA will return at a later date to conclude the investigation of the incident.

Per the California Code of Regulations, Title 22, Division 6, no deficiencies observed or cited. Exit interview held and a copy of report provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley BootheTELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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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