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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
502700517
Report Date:
11/26/2024
Date Signed:
11/26/2024 09:57:16 PM
Document Has Been Signed on
11/26/2024 09:57 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:
KIND CARE HOME II
FACILITY NUMBER:
502700517
ADMINISTRATOR/
DIRECTOR:
KAUR, KASHMINDER
FACILITY TYPE:
740
ADDRESS:
1020 JAYHAWK WAY
TELEPHONE:
(209) 523-0124
CITY:
MODESTO
STATE:
CA
ZIP CODE:
95358
CAPACITY:
6
CENSUS:
4
DATE:
11/26/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:
Care staff Carrie Wilson
TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to do an case management visit. LPA Lund met with care staff Carrie Wilson and explained the reason for the visit. Census: 4
The facility is going through a change of ownership. Care staff Carrie Wilson will be the new administrator for the new facility. LPA Lund will email information needed to have care staff Carrie Wilson change to the new administrator once reviewed by LPA Lund. Current administrator Kash Kaur is still doing the required hours at the facility.
No deficiencies were observed during this visit. Exit Interview and report given.
SUPERVISORS NAME
:
Lisa Rios
LICENSING EVALUATOR NAME
:
Jason Lund
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/26/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/26/2024
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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