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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700452
Report Date: 05/16/2024
Date Signed: 05/16/2024 09:09:40 PM

Document Has Been Signed on 05/16/2024 09:09 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:STANTON PLACEFACILITY NUMBER:
392700452
ADMINISTRATOR/
DIRECTOR:		CHESNEY, CHRISFACILITY TYPE:
735
ADDRESS:101 SEPULVEDA DRTELEPHONE:
(209) 403-8948
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 6CENSUS: 4DATE:
05/16/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
06:30 PM
MET WITH:James Perkett and Kaitlyn KellyTIME VISIT/
INSPECTION COMPLETED:
07:30 PM
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Unannounced case management visit made out to this off site location for this facility to conduct a Health and Wellness check by Licensing Program Analyst (LPA) Charlie Yang at this time.
This LPA was met by the care staff, James Perkett and Kaitlyn Kelly, and a brief interview was conducted with them at this time.
There were (4) residents present at this off site location at this time.
Medications were reviewed at this time. It was observed that medications were stored in the staff bedroom closet with handling and dispensing conducted by the care staff only.
A review of the resident clothing, personal items, and food items was conducted.
Meals were going to be provided by this facility staff and additional food items were going to be purchased and kept in the refrigerator at this time.
It was learned that all (4) residents will be present at this off site location and will return to the care home on 05/25/2024.
Day program attendance was still going to be in effect for (2) of the residents. It was learned that transportation was still going to be provided by the day program so that the residents could attend at this time.

There were no deficiencies observed or cited during today's case management visit.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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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