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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700266
Report Date: 09/10/2021
Date Signed: 09/29/2021 11:25:21 AM

Document Has Been Signed on 09/29/2021 11:25 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:CABRERA'S GUEST HOMEFACILITY NUMBER:
342700266
ADMINISTRATOR:CABRERA, DIGNAFACILITY TYPE:
735
ADDRESS:1229 SOUTH HARRISON STTELEPHONE:
(209) 598-7588
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 4CENSUS: 4DATE:
09/10/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Digna TIME COMPLETED:
11:23 AM
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Licensing Program Analyst (LPA) Albert Johnson made an unannounced case management visit - incident on 8/30/2021. Regional office received a reports regarding R1. LPA spoke with Digna Cabrera, Administrator.

LPA reviewed R1's incident report, R1 was sent to the ER to have a boil removed and to receive medication. LPA confirmed that R1 was given seven days of antibiotics and has completed the prescription.

R1 is back to her baseline without any need for further evaluation. Digna Cabrera contacted the family as well as Valley Mountain Regional Center.


No deficiencies were cited during today's visit. Exit interview conducted with Digna Cabrera.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2021
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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