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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005472
Report Date: 02/22/2023
Date Signed: 02/23/2023 10:48:18 AM

Document Has Been Signed on 02/23/2023 10:48 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:A DAY AWAYFACILITY NUMBER:
397005472
ADMINISTRATOR:LEAL-MALLETE, PENNYFACILITY TYPE:
775
ADDRESS:3550 WAGNER HEIGHTS RDTELEPHONE:
(209) 956-3400
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 15CENSUS: 0DATE:
02/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Maria BrownTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Kesha Lewis conducted an unannounced annual inspection on this date. LPA met with M. Brown and explained the purpose of the visit.

LPA inspected physical plant including but not limited to (1) Large recreation room and two (2) bathrooms and a patio area. LPA observed sufficient furniture and lighting throughout the program. The smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present.

First aid kit was checked and is complete. 0 Staff and 0 Resident’s records were reviewed the program is currently closed and has no staff. The program has not been operational since march 3rd 2020. They are currently planning for a June 2023 reopen.

LPA Observed no clients or staff at this time.

Per California Code of Regulations, Title 22 Division 6, Chapter 8 and Health and Safety Code, No Deficiencies were cited during this visit.

Exit interview held and a report given at the conclusion of the inspection.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
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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