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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317879
Report Date: 02/16/2022
Date Signed: 02/16/2022 03:18:08 PM

Document Has Been Signed on 02/16/2022 03:18 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:TACSION'S GUEST HOMEFACILITY NUMBER:
390317879
ADMINISTRATOR:TACSION, MYRNA L.FACILITY TYPE:
735
ADDRESS:4314 ESTATE DRIVETELEPHONE:
(209) 957-0185
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 6CENSUS: 5DATE:
02/16/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Marife De LeonTIME COMPLETED:
03:20 PM
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Licensing Program Analyst Bruce Jacobs conducted a Plan Of Correction case management visit at the care home to clear a citation issued to the facility. The facility was cited for inadequate storage of toxins and other item that could be hazardous to clients in care. LPA met with direct care staff and spoke to Facility Administrator Myrna Tacsion by phone. Upon that inspection in January 2022, the hazardous items were secured while LPA was present. The facility has conducted in-service training of all staff and the Facility Administrator will provide on-going compliance review of the care home. Citation cleared and clearance letter issued.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2022
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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