<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
392700306
Report Date:
10/11/2024
Date Signed:
10/14/2024 08:04:43 AM
Document Has Been Signed on
10/14/2024 08:04 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
SACRAMENTO SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
WAGNER HEIGHTS RESIDENTIAL
FACILITY NUMBER:
392700306
ADMINISTRATOR:
MANISHA PUNNI
FACILITY TYPE:
740
ADDRESS:
2435 WAGNER HEIGHTS RD
TELEPHONE:
(209) 477-5353
CITY:
STOCKTON
STATE:
CA
ZIP CODE:
95209
CAPACITY:
80
CENSUS:
72
DATE:
10/11/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:30 PM
MET WITH:
MANISHA PUNNI
TIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to conduct a case management visit regarding an email received from the Stockton fire department regarding them being called to left residents. LPA was greeted by Executive Director and explained the reason for the visit.
LPA Reviewed regulations with administrator regarding lifting residents and provided guidance.
LPA also toured the facility. Room temperature reads 75*F. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished with no foul odors noted. Smoke and carbon detectors were in good repair. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care.
Exit interview and copy of report given.
SUPERVISOR'S NAME:
Liza King
TELEPHONE:
(650) 676-0442
LICENSING EVALUATOR NAME:
Kesha Lewis
TELEPHONE:
(916) 764-1024
LICENSING EVALUATOR SIGNATURE:
DATE:
10/11/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1