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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500306146
Report Date: 06/15/2023
Date Signed: 06/15/2023 05:54:05 PM


Document Has Been Signed on 06/15/2023 05:54 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:LAS PALMAS ESTATESFACILITY NUMBER:
500306146
ADMINISTRATOR:MILLER, KREGGFACILITY TYPE:
740
ADDRESS:1617 COLORADOTELEPHONE:
(209) 632-8841
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:89CENSUS: DATE:
06/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Le Ann Blocker Resident Coordinator TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a case management visit. LPA Lund met with Le Ann Blocker Resident Coordinator and explained the reason for the visit.

On 6/14/2023 Community Care Licensing received a Unusual/Injury Incident Report (LIC624) that on 6/13/2023 Resident (R1) burned a flag in the dinning room of the facility. Staff called Turlock Police and Fire Department. Staff was able to stop the fire before it was out of control. R1 was taken into custody bye Turlock PD. LPA Lund observed the dinning very little damage was done to the dinning room and is still able to be used by resident’s in care.


No deficiencies were cited during this visit. Exit interview held and a report given.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
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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