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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701355
Report Date: 01/05/2024
Date Signed: 01/16/2024 11:01:46 AM

Document Has Been Signed on 01/16/2024 11:01 AM - 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:CLEO'S HOME 3FACILITY NUMBER:
392701355
ADMINISTRATOR:BRELIN, CLEOFACILITY TYPE:
740
ADDRESS:1662 DEDINI LNTELEPHONE:
(408) 512-4890
CITY:RIPONSTATE: CAZIP CODE:
95366
CAPACITY: 6CENSUS: 0DATE:
01/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:No One PresentTIME COMPLETED:
02:30 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
Unannounced case management visit made out to this facility on 01/05/2024 by Licensing Program Analyst (LPA) Charlie Yang at the address of 2372 Blue Tees Drive in Stockton, CA 95206. This LPA attempted to make contact with the facility staff, or any representatives, at this time.
After several attempts of ringing the doorbell and waiting for a response, this LPA retreated to his vehicle to attempt contact with the facility designated Administrator, Cleo Brelin, via telephone. This LPA was able to reach the facility designated Administrator on the phone. A brief interview was conducted with the facility designated Administrator at this time.
It was learned that this facility on Blue Tees no longer had any residents in care. The facility designated Administrator stated that all residents (2) had been relocated to Cleo's Home 2 located at 2426 West Alpine in Stockton, CA 95204 since 12/28/2023.
Current census was 0 residents.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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