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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
397005571
Report Date:
12/21/2023
Date Signed:
12/21/2023 04:50:15 PM
Document Has Been Signed on
12/21/2023 04:50 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 SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
ENCLAVE AT THE DELTA
FACILITY NUMBER:
397005571
ADMINISTRATOR:
LO, SUSAN
FACILITY TYPE:
735
ADDRESS:
4951 EIGHT MILE ROAD
TELEPHONE:
(209) 210-4863
CITY:
STOCKTON
STATE:
CA
ZIP CODE:
95212
CAPACITY:
45
CENSUS:
39
DATE:
12/21/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
04:15 PM
MET WITH:
Assistant Administrator Susan Lo
TIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an case management visit. LPA Lund met with Vice President Chief Operating Officer Madison Fetyko and Chief Administrative Officer Laura Li through teams and Assistant Administrator Susan Lo in person. LPA Lund explained the reason for the visit. Census 39.
On 12/20/2023 there was an incident that happened with Client (C1). LPA Lund came to the facility to gather documentation. The facility had house meeting regarding the incident with C1.
Exit Interview and report left
.
SUPERVISORS NAME
:
Lisa Rios
LICENSING EVALUATOR NAME
:
Jason Lund
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/21/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/21/2023
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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