<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507002509
Report Date: 05/24/2024
Date Signed: 05/24/2024 03:13:01 PM


Document Has Been Signed on 05/24/2024 03:13 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:STRATFORD AT BEYER PARK, THEFACILITY NUMBER:
507002509
ADMINISTRATOR:RODRIGUEZ, NICOLE EFACILITY TYPE:
740
ADDRESS:3529 FOREST GLENN DRTELEPHONE:
(209) 236-1900
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:107CENSUS: 78DATE:
05/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Nicole RodriguezTIME COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/24/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct a case management visit. LPA met with Facility Designated Administrator (FDA), Nicole Rodriguez and explained the purpose of the visit.

The purpose of this visit was to follow up on an eviction notice that was to be served to a current resident due to non-payment. LPA reviewed the eviction notice to ensure that all components to the eviction were included based on Title 22 regulations.

No deficiencies were observed or cited during the course of this visit.

An exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: (916) 862-5907
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1