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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700361
Report Date: 02/10/2021
Date Signed: 02/11/2021 05:00:48 PM

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:STACIE'S CHALET STOCKTONFACILITY NUMBER:
392700361
ADMINISTRATOR:PARKER, JADEFACILITY TYPE:
740
ADDRESS:517 E FULTON STTELEPHONE:
(209) 466-2116
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:114CENSUS: DATE:
02/10/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:LicensseeTIME COMPLETED:
02:00 PM
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An Office meeting was held on this day via Microsoft Teams to discuss the findings of the complaint investigation of the allegation noted above. Present at the meeting was Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Liza King, LPA Stephenie Doub, Auditor Diana Chapman and facility representatives James Wong, Patrica Wong, Jade Parker, Hatixhe Grbeshi, Robert Cantoria and Maria Cantoria.

Discussion occurred relating to the sale of each facility. The RO advised that the facility needed to review its closure plan that was previously submitted to CCL and assist residents in relocation if necessary. LPM King sent a copy of the closure plan to Jade Parker, Maria Cantero and Robbie Cantero during the meeting via email. The RO requested that the facility provide a current resident roster, with responsible party contacts to CCL by 2/16/2021. The RO will continue to monitor to ensure proper transition for the current residents in care in necessary.

The Department reviewed the current assistance that has been provided by CCL to include the TM in place, PPE deliveries and caregiver staffing assistance as a result of the Covid 19 outbreak at the facility. The Department also addressed its concerns related to the lack of COVID 19 infection control practices of the facility.

An exit interview was conducted with Facility Representatives and a copy of this report was provided via email. An electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Krystall MooreTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021
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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