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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701405
Report Date: 07/31/2024
Date Signed: 07/31/2024 12:29:24 PM


Document Has Been Signed on 07/31/2024 12:29 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:MOTHER'S HOUSE BY WESTSIDEFACILITY NUMBER:
502701405
ADMINISTRATOR:BROOKS, PATTY LYNNFACILITY TYPE:
740
ADDRESS:1032 SOUZA COURTTELEPHONE:
(209) 641-8679
CITY:NEWMANSTATE: CAZIP CODE:
95360
CAPACITY:6CENSUS: 0DATE:
07/31/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Patty Brooks, AdministratorTIME COMPLETED:
12:45 PM
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On 07/31/24, Licensing Program Analyst (LPA) Renee Campbell arrived at the facility announced to complete a pre-licensing inspection and verify requested changes. Upon entry, LPA Campbell met the Administrator Patty Brooks and Facility Manager William Brooks and explained the purpose of the visit. The following changes were made as required:

The curtain for the bathroom door near the entry of the residence has been replaced with an accordion folding door that could be closed and locked and fit the entryway from top to bottom.

The City of Newman Fire Department provided an updated Fire Safety Clearance that clarified the exception to the "Access to a public way" rule found in business code regulations for Building Egress (BE), BE 1028.5.
Pre-licensing has been passed and COMP III completed. The applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations. A copy of the report was left with the licensee.



SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024
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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