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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700109
Report Date: 03/07/2024
Date Signed: 03/07/2024 12:40:56 PM

Document Has Been Signed on 03/07/2024 12:40 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DELTA AT THE SHERWOODSFACILITY NUMBER:
392700109
ADMINISTRATOR:TANYA MONGEFACILITY TYPE:
740
ADDRESS:1215 W SWAIN ROADTELEPHONE:
(209) 689-3180
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 42CENSUS: DATE:
03/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sean Flannagan, Therapeutic Activity CoordinatorTIME COMPLETED:
01:30 PM
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On 03/07/24, Licensing Program Analyst Renee Campbell and Licensing Program Manager Lisa Rios arrived unannounced to the facility to open a new complaint.

As we toured the facility LPM Rios observed that there was a tray of prepared sandwiches on top of the counter. Per S3, the cook had just finished making sandwiches before leaving the facility and left them on the counter. At the request by LPM Rios, staff immediately put the sandwiches in the refrigerator. An advisory was then given to remind the cook to immediately place food in the fridge after prepping. No deficiencies were given. Exit interview.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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