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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004353
Report Date: 09/01/2022
Date Signed: 09/01/2022 01:31:23 PM


Document Has Been Signed on 09/01/2022 01:31 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
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:ARBOR PLACEFACILITY NUMBER:
397004353
ADMINISTRATOR:BELINDA GUZMANFACILITY TYPE:
740
ADDRESS:17 LOUIE AVETELEPHONE:
(209) 369-8282
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:76CENSUS: DATE:
09/01/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Debbie SnaithTIME COMPLETED:
02:30 PM
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Licensing Program Analysts (LPA's) Kesha Lewis and Albert Johnson arrived at the facility unannounced to conduct a Plan of correction visit for citations given on the case management visit on 08/18/2022.


During the visit on 9/01/2022 LPA'S requested information for compliance for citations cited during the inspection. The facility cleared one citation obtained on 8/18/2022, and the other is due 9/15/2022 LPA'S will come back at a later date. Citation cleared on today's visit.


One Deficiencies from the visits on 8/18/2022 has been cleared.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
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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