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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 057001380
Report Date: 10/19/2022
Date Signed: 10/19/2022 05:29:06 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/19/2022 05:29 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.270
SACRAMENTO, CA 95833
FACILITY NAME:WATCH-GOLDSTRIKEFACILITY NUMBER:
057001380
ADMINISTRATOR:CHRISTINA GARIBAYFACILITY TYPE:
735
ADDRESS:342 GOLDSTRIKE ROADTELEPHONE:
(209) 754-3773
CITY:SAN ANDREASSTATE: CAZIP CODE:
95249
CAPACITY: 12CENSUS: 5DATE:
10/19/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH: Meleani Wheeler, Supportive Living Instructor TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Renee Campbell made an unannounced visit on this day at approximately 09:30 AM. for the purpose of conducting an abbreviated annual inspection. An annual inspection was previously conducted on 03/21/22, LPA Campbell met with Supportive Living Instructor, Meleani Wheeler and observed the following

· Covid precautions being followed


· Interior and exterior of the plant observed
· (7) seven-day non-perishable and (2) day perishable supply of food
· Fire extinguisher fully charged. Last checked on 10/01/22
· Smoke detectors all operational.
· Hot water temperature measured at 107 degrees Fahrenheit..
· Displayed Emergency Disaster plan dated 03/22/2022.

There are no Health and Safety concerns currently. Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was left with Supportive Living Instructor, Meleanie Wheeler.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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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