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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700352
Report Date: 11/22/2022
Date Signed: 11/22/2022 11:40:44 AM

Document Has Been Signed on 11/22/2022 11:40 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:BRICKS COMMUNITY CARE HOMEFACILITY NUMBER:
392700352
ADMINISTRATOR:LIMBRICK, ANTHONYFACILITY TYPE:
735
ADDRESS:3917 MARCHESOTTI WAYTELEPHONE:
(209) 362-5600
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 4CENSUS: 3DATE:
11/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:LIMBRICK, ANTHONYTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA's) Kesha Lewis and Albert Johnson arrived at this facility unannounced to conduct a quarterly unannounced visit. LPA's was met by Administrator Anthony Limbrick of the LPA's explained the purpose of the visit. Administrator Certificate Expires 5/6/2024.

Department will conduct quarterly unannounced visits to monitor and address the following but not limited to: (1) Resident rights, (2) Driver’s safety training, (3) Reporting requirement training, (4) Training on when to provide medical care.

A review of (2) facility resident records was conducted and have all required documents for Community Care Licensing (CCL). A review of (5) facility personnel records was conducted. All staff is fingerprint cleared and associated to the facility. All staff have current First Aid certifications on file. Facility is conducting initial and continuing training as required. Copies taken.

LPA's and staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations.


No citations issued today. An exit interview was conducted with Anthony Limbrick and a copy of this report was left.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
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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