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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700181
Report Date: 08/08/2024
Date Signed: 08/08/2024 01:51:03 PM

Document Has Been Signed on 08/08/2024 01:51 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:NEW VISION SERVICES SOUTH 2FACILITY NUMBER:
392700181
ADMINISTRATOR/
DIRECTOR:
TANYA SLOANFACILITY TYPE:
735
ADDRESS:10250 VAUGHN DRIVETELEPHONE:
(530) 605-4437
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 6CENSUS: 5DATE:
08/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:48 PM
MET WITH:Tanya SloanTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 08/08/2024 at 12:48 PM, Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Tanya Sloan and explained the purpose of the visit.

LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate. The facility is licensed for 5 ambulatory clients and 1 non-ambulatory client. There are currently 5 clients who reside at this facility.

The LPA Martinez toured the facility with Tanya Sloan on 08/08/2024 at 1:00 PM.

LPA Martinez reviewed 3 client files and 3 staff files, which were complete and maintained. LPA Martinez reviewed 1 medication administration record and 1 PNI ledger, which were maintained. The facility has a first aid kit. The facility fire extinguishers, carbon detectors, and smoke detectors are in good repair. The exterior emergency exit gate is in good repair. The facility common areas, bedrooms, bathrooms, laundry room were furnished and sanitary. Facility water temperature measured at 112 degrees, and the facility temperature measured at 72 degrees. The facility has an adequate food supply.

Based on this annual inspection there were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was given to the facility at the end of the visit.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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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