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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002682
Report Date: 08/20/2024
Date Signed: 08/21/2024 08:09:16 AM


Document Has Been Signed on 08/21/2024 08:09 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: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:
08/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Elenor LauroraTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct a case management visit. LPA met with and explained the purpose of the visit.

This is in response to Civil penalties and the facility requesting a payment arrangement for the following invoice: (1) Invoice 500021364, Assessed on 10/09/2023 for the amount of $9,500.

Your request for the total of $9,500 to be on a payment plan has been approved and will begin on September 1st, 2024. A monthly payment of $950 will be required. Monthly payments are due by the 1st of each month for the next 10 months. Failure to make a payment by the 1st of each month will void your payment plan and the entire balance will become due and payable. Partial payments will not be accepted. This payment plan only applies to the civil penalties listed above. The final payment is due on or before May 1st, 2025.

The Department only accepts checks or money orders. When sending in payment, please include the invoice number and facility number on the check or money order.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUNNY PLACE OF STOCKTON
FACILITY NUMBER: 397002682
VISIT DATE: 08/20/2024
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Make the check or money order payable to CDSS. Mail the payment to:

Exit interview conducted
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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