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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700869
Report Date: 04/01/2022
Date Signed: 04/01/2022 01:07:32 PM


Document Has Been Signed on 04/01/2022 01:07 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:ORANGEBURG MANORFACILITY NUMBER:
502700869
ADMINISTRATOR:ARBIOS, MARIEFACILITY TYPE:
740
ADDRESS:1248 NELSON AVENUETELEPHONE:
(209) 527-2222
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:90CENSUS: 25DATE:
04/01/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator Alma Whitted TIME COMPLETED:
01:15 PM
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LPA Jason Lund arrived unannounced to complete a proof of correction (POC) visit. LPA Lund met with Administrator Alma Whitted and explained the reason for the visit.

On 12/17/2021 the facility received a deficiency regarding a complaint. Administrator Alma Whitted on 4/1/2022 sent LPA Lund an email stating she has looked over the regulation and understands the regulation. LPA Lund received the email and will generate a POC letter for the facility.


Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies were observed and cited during this visit. Facility is in substantial compliance on this date. Exit interview held with Administrator Alma Whitted and a copy of report given at the conclusion of the visit.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/01/2022
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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