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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700500
Report Date: 08/03/2023
Date Signed: 08/03/2023 04:41:13 PM

Document Has Been Signed on 08/03/2023 04:41 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:GLENBROOK CARE HOME LLCFACILITY NUMBER:
392700500
ADMINISTRATOR:CABRERA, ELISEOFACILITY TYPE:
735
ADDRESS:6002 GLENBROOK LNTELEPHONE:
(209) 598-0303
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 4CENSUS: 4DATE:
08/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Digna CabreraTIME COMPLETED:
04:50 PM
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On 8/3/23 at approximately 2pm Licensing Program Analyst (LPA_ Maja Jensen arrived at facility unannounced to conduct a required annual visit. LPA Jensen met with Administrators Digna Cabrera and Eliseo Cabrera and explained the purpose of today's visit. Eliseo Cabrera holds current Administrator's certificate # 6020179735 good through 10/7/2024.

LPA Jensen toured the grounds and observed them to be maintained and with all pathways clear of obstruction. There are no bodies of water on the property. The facility maintains outdoor furniture for resident use and there are shaded areas available. The interior of the facility was observed to be sanitary and free of odor. LPA Jensen observed postings for Resident Rights, Resident Council, "See Something, Say Something", facility sketch, and first aid. The Emergency Disaster Plan was last updated in January of 2023 and is in compliance. The facility maintains emergency battery operated lighting and and a disaster supply box. Fire drills are conducted monthly. The fire extinguisher was last serviced in June of 2023 and is in compliance. The carbon monoxide detector and smoke detector were tested and found to be in good working order. LPA Jensen observed adequate lighting throughout. There is a sufficient supply of linen available.

The thermostat was set at 77 degrees Fahrenheit upon arrival which falls within the required range of 68-85 degrees. Resident bedrooms were observed to have all required furniture. The water temperature in the kitchen was measured at 107 degrees which falls within the required range. The garbage cans throughout the facility were equipped with tight fitting lids. The facility maintains a 2 day supply of perishable food and a 7 day supply of non-perishable food. All cans and food taken out of it's original packaging is labeled with an expiration date. There is fresh fruit and produce available. Medication and toxins are locked and inaccessible to residents in care. LPA Jensen did a random medication audit and found the record keeping to be accurate. The facility handles P&I funds. LPA Jensen conducted a random audit of P&I funds and found the accounting to be to accurate.

Continued on LIC 809C....

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: GLENBROOK CARE HOME LLC
FACILITY NUMBER: 392700500
VISIT DATE: 08/03/2023
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LPA Jensen reviewed 4 of 4 resident files. LPA Jensen reviewed 2 of 5 staff files and found them to be complete. LPA Jensen interviewed 2 of 4 clients and 1 of 2 staff members on duty. LPA Jensen observed all clients to have their needs attended to.

The full inspection tool was used for the purposes of this inspection. The facility was found to be in substantial compliance and no deficiencies were issued.

An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
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