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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803851
Report Date: 05/15/2023
Date Signed: 05/15/2023 11:48:04 AM

Document Has Been Signed on 05/15/2023 11:48 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:TELECARE BECK LANEFACILITY NUMBER:
486803851
ADMINISTRATOR:JENNINGS, MONTELFACILITY TYPE:
738
ADDRESS:4500 BECK LANETELEPHONE:
(707) 299-9041
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 4CENSUS: 4DATE:
05/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator, Montel JenningsTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi conducted an unannounced Case Management-Other inspection at Telecare Beck Lane. LPA was greeted at the door by Montel Jennings, and was granted access into the facility. The purpose of this Case Management-Other inspection is to follow up on an Order of Immediate Exclusion letter issued on May 4, 2023.

During the Case Management-Other inspection, Administrator confirmed Excluded Staff Member is not working in the facility or residing in the facility and has never worked at this facility. LPA obtained a copy of the Resident Roster, LIC 500 and the staff schedule. In addition, LPA toured the facility. Excluded Staff Member was not seen on the premises. Based on evidence obtained during today’s Case Management-Other Inspection, the LPA has verified Excluded Staff Member is not present, employed, or residing at the facility. Verification of removal is complete.

No deficiencies were observed or cited during today's Case Management-Other inspection. Exit interview was conducted and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
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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