<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
500300107
Report Date:
09/05/2024
Date Signed:
09/05/2024 12:30:28 PM
Document Has Been Signed on
09/05/2024 12:30 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:
53
DATE:
09/05/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:30 AM
MET WITH:
Administrator Stephany Issakhani
TIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) arrived unannounced to conduct a case management visit. LPA met with Administrator Stephany Issakhani and explained the purpose of the visit. Census: 53
As of 9/5/2024 the facility will be completed a change of ownership. They turned in the facility license as of today.
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:
09/05/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1