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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397003261
Report Date: 12/17/2021
Date Signed: 12/17/2021 06:56:42 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:BROOKDALE TRACYFACILITY NUMBER:
397003261
ADMINISTRATOR:PAMELA BRADLEYFACILITY TYPE:
740
ADDRESS:355 W GRANT LINE RDTELEPHONE:
(209) 835-1000
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:180CENSUS: 44DATE:
12/17/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:47 PM
MET WITH:Sarah Mackedsky, Executive DirectorTIME COMPLETED:
03:00 PM
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LPA Garcia visited the facility to deliver an Amended Report and Clear the Citation. LPA observed Resident President meeting with the Executive Director confirming receipt of the response letter to resolution meeting requests. LPA observed Resident Council agreeing to the meeting and confirming time with ED.

Per the POC the ED was to review past resident council submitted written concerns or recommendations and provide a written response. ED provided LPA a copy of letter via email and acknowledged letter was sent to President which requested for a meeting to discuss.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arlene D GarciaTELEPHONE: 916-862-5907
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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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