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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
507002304
Report Date:
02/14/2024
Date Signed:
02/14/2024 03:14:10 PM
Document Has Been Signed on
02/14/2024 03:14 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:
HAVEN, THE
FACILITY NUMBER:
507002304
ADMINISTRATOR:
RECTO, GENOVEVA
FACILITY TYPE:
740
ADDRESS:
3636 N. VENEMAN AVENUE
TELEPHONE:
(209) 300-7323
CITY:
MODESTO
STATE:
CA
ZIP CODE:
95356
CAPACITY:
6
CENSUS:
0
DATE:
02/14/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:30 PM
MET WITH:
No one
TIME COMPLETED:
03:15 PM
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On 2/14/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to verify that there are no clients in care as the Licensee has informed the facility has closed. LPA Jensen rang the door bell and there was no answer.
The property appeared to be unoccupied. LPA Jensen was able to look through the front entrance window and see several mattresses piled up in the living room. The back yard gate was open and there were wood pallets along the side of the home. LPA Jensen observed satellite TV equipment at the front door that appeared to be laid out for pick up. LPA Jensen called Linda Gacayan and the phone number was disconnected. LPA Jensen called a different number on file for the Licensee and it was a wrong number. LPA Jensen called the facility phone number and there was no answer.
This report will be mailed to the Licensee in the event that there is a forwarding address on file with the Post Office.
SUPERVISOR'S NAME:
Lisa Rios
TELEPHONE:
(916) 969-9685
LICENSING EVALUATOR NAME:
Maja Jensen
TELEPHONE:
(916) 639-5584
LICENSING EVALUATOR SIGNATURE:
DATE:
02/14/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/14/2024
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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