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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507002679
Report Date: 04/23/2024
Date Signed: 04/24/2024 07:54:09 AM

Document Has Been Signed on 04/24/2024 07:54 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:SHERWOOD FOREST MANOR 2FACILITY NUMBER:
507002679
ADMINISTRATOR/
DIRECTOR:		RONALDO DATOFACILITY TYPE:
740
ADDRESS:601 E. RUMBLE ROADTELEPHONE:
(209) 577-1247
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 6CENSUS: 3DATE:
04/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Ronaldo Dato TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 04/23/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a case management visit. LPA met with Facility Designated Administrator (FDA), Ronald Dato and explained the purpose of the visit.

The purpose of this visit was to follow up on a Decision and Order in regards to S1 who was deemed to be excluded from being present, employed, or have any contact with any licensed facility by the Department. It was learned that the facility has not obtained the Decision and Order pertaining to S1 to this date. LPA learned that S1 last worked at this facility on 04/22/2024. LPA notified FDA Dato that S1 can no longer work any licensed facility.

A tour of the facility was conducted to confirm S1 was not present.

There were no deficiencies observed or cited during today's case management visit.

An exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
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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