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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002885
Report Date: 10/05/2023
Date Signed: 10/20/2023 01:20:36 PM


Document Has Been Signed on 10/20/2023 01:20 PM - It Cannot Be Edited

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:STONEBRIDGE CARE FACILITYFACILITY NUMBER:
397002885
ADMINISTRATOR:SANTILLAN, LORNA & DANILOFACILITY TYPE:
740
ADDRESS:555 DEERWOOD AVENUETELEPHONE:
(510) 938-8602
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY:6CENSUS: 0DATE:
10/05/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lorna Santillan TIME COMPLETED:
01:30 PM
NARRATIVE
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On 10/05/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived at facility announced to conduct a case management visit. LPA met with Licensee Lorna Santillan and explained the purpose of the visit. A Notice of Facility Closure was received with a facility closure date of 10/05/2023 The facility has been vacant did not have any residents in care for over a year.

LPA Pascua conducted a tour of the facility with Licensee Santillan. A tour of the interior and exterior of the facility was conducted, including the front and backyards, living room, dining room, kitchen, bathrooms, and all bedrooms. LPA Pascua observed that there were no residents at the facility.

LPA obtained the original license. LPA will close the facility in the system. LPA Pascua discussed the facility closure survey that will need to be conducted prior to closing.

A copy of this report was provided to the Licensee.

Link to survey for Facility Closure provided to Licensee.
www.surveymonkey.com/r/facilityclosure
Exit interview conducted.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2023
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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