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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700364
Report Date: 07/09/2024
Date Signed: 07/09/2024 02:24:26 PM

Document Has Been Signed on 07/09/2024 02:24 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:QUINTAL CARE HOMEFACILITY NUMBER:
392700364
ADMINISTRATOR/
DIRECTOR:		QUINTAL, JUDYFACILITY TYPE:
735
ADDRESS:10796 WINWARD AVENUETELEPHONE:
(209) 957-7128
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 4CENSUS: 3DATE:
07/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:QUINTAL, JUDYTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analysts (LPA) Kesha Lewis arrived at the facility unannounced for the purpose of conducting a case management incident inspection regarding incident report received 05/16/2024. LPA explained purpose of visit to the administrator.

The incident report was regarding an incident for R1 while at day program, R1 wrote a suicide note and showed it to other people at person centered services Lodi and they gave it to the program director. Responsible parties were notified and R1 was taken to crisis services at Dameron hospital in Stockton and was held overnight then seen by a suicide therapist. The facility has moved R1 to a new day program. as of 06/19/2024. Needs and services plan was updated.

Per California Code of Regulations, Title 22 no deficiencies were observed or being cited during today's case management inspection.

An exit interview was conducted and a copy of this report was given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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