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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
507005604
Report Date:
08/05/2024
Date Signed:
08/05/2024 12:11:04 PM
Document Has Been Signed on
08/05/2024 12:11 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:
ASTORIA AT OAKDALE
FACILITY NUMBER:
507005604
ADMINISTRATOR/
DIRECTOR:
JACQUELINE HERNANDEZ
FACILITY TYPE:
740
ADDRESS:
700 LAUREL AVE
TELEPHONE:
(209) 847-0864
CITY:
OAKDALE
STATE:
CA
ZIP CODE:
95361
CAPACITY:
45
CENSUS:
37
DATE:
08/05/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:
Margarita Guizar
TIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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LPA Jensen arrived at facility to conduct an annual inspection. LPA Jensen met with Administrative assistant Margarita Guizar and explained the purpose of today's visit. Due to equipment issues LPA was unable to complete the visit and will return at a later date.
SUPERVISORS NAME
:
Lisa Rios
LICENSING EVALUATOR NAME
:
Maja Jensen
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/05/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/05/2024
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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