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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577003959
Report Date: 06/30/2023
Date Signed: 06/30/2023 01:40:07 PM


Document Has Been Signed on 06/30/2023 01:40 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
CCLD Regional Office, 2525 NATOMAS PARK DR., STE 260
SACRAMENTO, CA 95833



FACILITY NAME:CENTER FOR POSITIVE CHANGESFACILITY NUMBER:
577003959
ADMINISTRATOR:STACI EXCEUS ADMINISTRATORFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 0DATE:
06/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Staci Exceus, Administrator TIME COMPLETED:
01:50 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 6/30/23 Licensing Program Analyst (LPA) Jacqueline Carmona conducted an on-site inspection to the above facility. LPA met with the Staci Exceus, Administrator. The purpose of this inspection was to confirm that the Short Term Residential Therapeutic Program (STRTP) had been vacated of clients. LPA Carmona was given a tour of the interior and exterior of the home. There were no indications of ongoing placement's observed. During todays on site inspection LPA Carmona was formally notified of this closure via an in person conversation. LPA Carmona will be provided a written closure request letter by end of business day today.

The reason for the closure is due to the facility loosing the letter of support from Yolo County. The posted license was surrendered. The Regional Office is in agreement to waive 50% of the annual fees totaling $227. The facility will be closed effective 6/30/23.

No citations were issued as a result of this inspection. Exit interview conducted; a copy of this report was provided to Staci Exceus, Administrator .

SUPERVISOR'S NAME: Rosa RodriguezTELEPHONE: (916) -662-1458
LICENSING EVALUATOR NAME: Jacqueline CarmonaTELEPHONE: 916-838-8761
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2023
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