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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
502701044
Report Date:
04/27/2022
Date Signed:
04/28/2022 09:46:20 AM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
04/28/2022 09:46 AM
- 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:
ANGEL'S CARING HAND
FACILITY NUMBER:
502701044
ADMINISTRATOR:
ANTONIO, MA TABITHA
FACILITY TYPE:
740
ADDRESS:
3709 COYE OAK DR
TELEPHONE:
(209) 312-9880
CITY:
MODESTO
STATE:
CA
ZIP CODE:
95355
CAPACITY:
6
CENSUS:
5
DATE:
04/27/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
01:29 PM
MET WITH:
TIME COMPLETED:
03:30 PM
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SUPERVISOR'S NAME:
Stephenie Doub
TELEPHONE:
(916) 263-2131
LICENSING EVALUATOR NAME:
Albert Johnson
TELEPHONE:
(916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE:
04/27/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/27/2022
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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