Community Care Licensing

Document Has Been Signed on 05/16/2023 04:50 PM - It Cannot Be Edited

FACILITY NAME:	WILTON STABLES		FACILITY NUMBER:	342700065
ADMINISTRATOR:	TANYA BARRETO		FACILITY TYPE:	735
ADDRESS:	11119 MANN ROAD		TELEPHONE:	(916) 687-4548
CITY:	WILTON	STATE: CA	ZIP CODE:	95693
CAPACITY: 4		CENSUS: 4	DATE:	05/16/2023
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	Tori Quijano		TIME COMPLETED:	03:24 PM

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LPA Albert Johnson made an unannounced POC visit to the facility to verify correction of citations issued during the annual visit conducted on 5/5/23. LPA toured the facility, reviewed document submitted for plans of correction observed that the some deficiencies cited on 5/5/23 have been cleared. The following deficiencies, initially cited during a visit on 05/05/2023, have been cleared: Section Cited: 80020(a) Date Due: 05/06/2023 Plan of Correction: The facility will remove the cabinet from blocking the door and submit a plan for the repair or replacement of the door leading out of the garage by POC Date 5/6/2023 Corrections: Cleared By Visit Clearance Date: 05/16/2023 Section Cited: 80087(g)(1) Date Due: 05/06/2023 Plan of Correction: Administrator will conduct an in-service training with staff regarding proper storage for toxins and items that may cause a danger. Curriculum and date of training to be sent into CCL on 05/06/2023. Corrections: Cleared By Visit Clearance Date: 05/16/2023 Facility was provided POC cleared letter. Exit interview conducted and a copy of this report was left at the facility.

SUPERVISORS NAME: Stephenie Doub LICENSING EVALUATOR NAME: Albert Johnson LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023