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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700361
Report Date: 06/03/2021
Date Signed: 06/03/2021 12:19:14 PM

Document Has Been Signed on 06/03/2021 12:19 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:STACIE'S CHALET STOCKTONFACILITY NUMBER:
392700361
ADMINISTRATOR:KARON MILLSFACILITY TYPE:
740
ADDRESS:517 E FULTON STTELEPHONE:
(209) 466-2116
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 114CENSUS: 53DATE:
06/03/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Karon Mills, Executive DirectorTIME COMPLETED:
12:35 PM
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Licensing Program Analyst Bruce Jacobs conducted a facility visit to conduct a Health and Safety check. Food supplies were inspected and determined to be adequate. Meal preparation was in progress, the lunch meal was observed and the facility was following the posted menu. LPA inspected and monitor the air-conditioning units and facility temperature. The facility's main air conditioning unit is not working and has not been working for approximately the last 30 days. The facility has bought in 10 large portable air conditioning units and is working with the property owner for a long term solution. The facility was toured and the temperature through out the care home was measured at 79 degrees F.

No deficiencies were identified on this visit
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2021
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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