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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700352
Report Date: 05/04/2023
Date Signed: 05/04/2023 02:46:44 PM

Document Has Been Signed on 05/04/2023 02:46 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: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:
05/04/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Anthony LimbrickTIME COMPLETED:
03:00 PM
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On 5-4-23 at 1:35pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct a quarterly health and safety check. LPA met with the administrator Anthony Limbrick and explained the purpose of the visit.

LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 4-bed facility with a current census of 3.

Water temperature reads between 105*F and 120*F in the bathroom and room temperature reads 71*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Facility has an emergency food and water kit. All sharp objects, chemicals, and other dangerous items were locked and inaccessible to residents in care.

LPA reviewed 3 resident files and 3 staff files. Files reviewed contained all required regulatory contents. LPA additionally observed completed staff training on Resident rights, Driver’s safety training, Reporting requirement training, and training on when to provide medical care.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Anthony Limbrick
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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