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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700312
Report Date: 02/09/2023
Date Signed: 02/09/2023 03:51:36 PM

Document Has Been Signed on 02/09/2023 03:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:PERSON CENTERED SERVICES, INC. #1FACILITY NUMBER:
392700312
ADMINISTRATOR:MOORE, LAURAFACILITY TYPE:
775
ADDRESS:722 W MARCH LNTELEPHONE:
(209) 466-2448
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 255CENSUS: 84DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Laura MooreTIME COMPLETED:
04:00 PM
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On 2/9/23 at approximately 2pm Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual inspection. LPA Jensen met with Administrator Laura Moore and explained the purpose of today's visit.

LPA Jensen toured the facility including but not limited to classrooms, cafe rooms, computer labs, janitorial rooms, bathrooms. The facility was determined to be sanitary and free of odor. There was sufficient lighting observed throughout. The temperature ranged between 69 and 72 degrees for the comfort of the clients which falls within the required regulatory range of 68-85 degrees Fahrenheit. There are numerous activities available for clients and variety of classroom types including classrooms designated for Music, exercise, academics and life skills. The facility has a janitorial room and that is the only place toxins and chemicals are stored. The bathrooms were observed to have grab bars. There are two cafeteria style rooms for eating lunches or gathering. There are no sharp objects accessible to the student body. The LIC 610D.

The facility does not administer medication. Any client that participates in the program and needs to take medication has physician approval on file for self administration. There is an isolation room available for anyone experiencing symptoms of illness. The facility maintains an adequate supply of PPE and conducts response testing for any COVID as needed. The infection control inspection tool was used during the course of this annual inspection and the facility was found to be in substantial compliance.

LPA Jensen requested an LIC 500 and a copy of the current liability insurance be emailed to the LPA by 2/16/23.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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