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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
500300107
Report Date:
05/06/2024
Date Signed:
05/06/2024 01:44:58 PM
Document Has Been Signed on
05/06/2024 01:44 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:
CASA DE MODESTO
FACILITY NUMBER:
500300107
ADMINISTRATOR:
STEPHANY ISSAKHANI
FACILITY TYPE:
740
ADDRESS:
1745 ELDENA WAY
TELEPHONE:
(209) 529-4950
CITY:
MODESTO
STATE:
CA
ZIP CODE:
95350
CAPACITY:
84
CENSUS:
49
DATE:
05/06/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Administrator Stephany Issakhani
TIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jason arrived unannounced to conduct a case management visit. LPA met with Administrator Stephany Issakhani and explained the purpose of the visit. Census: 49
Casa Da Modesto continues to meet quotas in the for staffing and the needs of the residents in care. Administrator Stephany Issakhani will notify LPA Jason Lund of any changes or updates.
No deficiencies during today’s visit. Exit Interview and report left.
SUPERVISOR'S NAME:
Lisa Rios
TELEPHONE:
(916) 969-9685
LICENSING EVALUATOR NAME:
Jason Lund
TELEPHONE:
(916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE:
05/06/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/06/2024
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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