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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700581
Report Date: 07/27/2023
Date Signed: 08/03/2023 03:43:14 PM


Document Has Been Signed on 08/03/2023 03:43 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:GATE OF BEAUTIFUL II, THEFACILITY NUMBER:
502700581
ADMINISTRATOR:NICOLE ELLFACILITY TYPE:
740
ADDRESS:3300 SHARON AVETELEPHONE:
(209) 526-2425
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:6CENSUS: 3DATE:
07/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sarena Arias TIME COMPLETED:
02:00 PM
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On 07/27/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived to this facility unannounced to conduct a case management visit. LPA was greeted by staff member (SM), Carolyn Lane and explained the purpose of the visit. LPA asked SM Lane to call the Facility Designated Representative, Sarena Arias to inform her that CCL was present.

Shortly after, LPA met with FDR Sarena Arias and explained the purpose of the visit.

The purpose of the visit was to follow up on information that was gathered from the annual visit conducted on 05/04/2023. On 05/04/2023, it was learned that the facility transitioned to a vendorization from Valley Mountain Regional Center. LPA asked the Licensee to change the Plan of Operation to reflect the recent change. As of today's visit, 07/27/2023, the department has not received any documentation.
LPA asked that the new Plan of Operation be sent to the LPA by 08/18/2023. The facility representative was informed that failure to provide documentation by due date may result in deficiencies.

No deficiencies cited on this day.
An exit interview was conducted. A copy of this report was provided to the Facility at the end of this visit.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
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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