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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
397005730
Report Date:
05/04/2017
Date Signed:
07/24/2024 01:33:58 PM
Document Has Been Signed on
07/24/2024 01:33 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
,
2525 NATOMAS PARK DR. STE.270
SACRAMENTO
,
CA
95833
FACILITY NAME:
EPJ'S CARE HOMES #2
FACILITY NUMBER:
397005730
ADMINISTRATOR:
PATACSIL JR, ERNESTO
FACILITY TYPE:
735
ADDRESS:
311 MISSION PARK DR
TELEPHONE:
(209) 477-4799
CITY:
STOCKTON
STATE:
CA
ZIP CODE:
95207
CAPACITY:
6
CENSUS:
DATE:
05/04/2017
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:31 PM
MET WITH:
TIME COMPLETED:
02:32 PM
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Attempted visit
SUPERVISORS NAME
:
Sidney Davis
LICENSING EVALUATOR NAME
:
Albert Johnson
LICENSING EVALUATOR SIGNATURE
:
DATE:
05/04/2017
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/04/2017
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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