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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005604
Report Date: 12/30/2021
Date Signed: 12/30/2021 01:49:41 PM

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:ASTORIA AT OAKDALEFACILITY NUMBER:
507005604
ADMINISTRATOR:JACQUELINE HERNANDEZFACILITY TYPE:
740
ADDRESS:700 LAUREL AVETELEPHONE:
(209) 847-0864
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY:45CENSUS: 33DATE:
12/30/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:J HernandezTIME COMPLETED:
11:46 AM
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LPA Johnson arrived unannounced to clear the POC's from visit dated 02/01/2021. The following deficiencies, initially cited during a visit on 02/01/2021, have been cleared:


Section Cited: 87211(a)(2)Date Due: 02/15/2021
Plan of Correction:
Licensee agrees to submit plan to be in compliance with this regulation to LPA by POC due date of 2/15/2021		Corrections:
Cleared By Visit		Clearance Date:
12/30/2021
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021
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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