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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700451
Report Date: 02/07/2022
Date Signed: 02/07/2022 01:53:45 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/07/2022 01:53 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:CHESNEY PROFESSIONAL CAREFACILITY NUMBER:
392700451
ADMINISTRATOR:CHESNEY, CHRISFACILITY TYPE:
735
ADDRESS:7163 UYEDA RDTELEPHONE:
(209) 403-8948
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY: 15CENSUS: 9DATE:
02/07/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Chris Chesney - AdministratorTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced a Required 1-year Annual Inspection and met with Administrator. LPA observed Administrator Certificate expires on 2/17/2022.

LPA inspected physical plant with Administrator and toured inside and outside to ensure the safety of the clients. LPA observed kitchen, laundry rooms, restrooms, bedrooms, and common living areas and backyard, LPA observed the pool gates locked and in accessible to clients. The temperature inside the facility was measured at 73*F which is within the required range of 68*F and 85*F, or in areas of extreme heat the maximum shall be 30*F less than the outside temperature. The hot water was measured at 109.5*F in kitchen sink which is within regulatory range of not less than 105*F and not more than 120*F. The first aid kit was found in compliance containing at least the following: a current edition of an approved first aid manual, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and antiseptic solution. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days maintained on site.

LPA observed COVID precautions signs posted, restrooms stocked with paper towels, hand-free soap, hand-free covered trash cans, and posted hand washing signs. 30 day supply of PPE stored on site. Administrator stated common surfaces are disinfected three times daily and in between use. LPA observed hand sanitizer available throughout the facility.

Facility handles P & I monies, LPA observed the log is maintained correctly and there is no commingling of funds. LPA observed fire extinguishers expire 4/16/2022, pull alarm system, smoke and carbon monoxide detectors, central heating and air in the facility. LPA observed facility is on private water supply, LPA observed the facility conducts fire drills documented monthly.

Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies are being cited on today's date. Exit interview held and a copy of report was given to administrator.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2022
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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