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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700312
Report Date: 02/15/2024
Date Signed: 02/15/2024 01:39:01 PM

Document Has Been Signed on 02/15/2024 01:39 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: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: 117DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Renee ElliottTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced on 2/15/2024 to conduct an annual inspection. LPA met with Renee Elliott and explained the purpose of the visit.

This is a Regional Center funded 515(service code) behavior management program with an expected 1 Staff to 3 Student ratio. LPA inspected the physical plant including but not limited to the kitchen/ dining areas, classrooms, laundry area and activity rooms and main entrance inside and outside. LPA observed sufficient furniture and lighting throughout the facility. LPA observed food supplies used for the Student's store with current dates on items for sell. Hot water temperature was measured at 115.9 degrees Fahrenheit in Student bathroom sink, which is within the required range of 105 to 120 degrees.

Fire extinguishers and smoke detector are operational. Medications are not distributed at this facility. LPA reviewed 7 Student and 10 Staff files, including criminal record clearances. All Staff reviewed are cleared and associated to this facility. First aid kits were checked and they are all complete. LPA observed carbon monoxide detectors in the facility. The facility last conducted a fire drill on 1/2024.

No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes.

Exit interview conducted.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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