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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700500
Report Date: 07/25/2024
Date Signed: 07/26/2024 09:39:43 AM

Document Has Been Signed on 07/26/2024 09:39 AM - 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:GLENBROOK CARE HOME LLCFACILITY NUMBER:
392700500
ADMINISTRATOR/
DIRECTOR:		CABRERA, ELISEOFACILITY TYPE:
735
ADDRESS:6002 GLENBROOK LNTELEPHONE:
(209) 598-0303
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 4CENSUS: 4DATE:
07/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:13 PM
MET WITH:Eliseo and DignaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 7/25/24, LPA Albert Johnson arrived announced at the facility to conducted the annual inspection.

This is a Level 4 I care home vendored by Valley Mountain Regional Center. The Regional Center conducted a HCBS inspection on June 18, 2024. LPA was able to review the completed inspection, the facility met all requirements for the survey.

LPA conducted a tour of the facility. LPA observed the back yard with secure fence and no pool or body of water observed. All hallways and passageways are free of clutter or hazards. The resident rooms and living areas to be adequately furnished.

There is adequate supply of linens and the first aid kits is equipped. Emergency exit and phone number are posted. Water temperature in bathroom is at 112.5 degrees F. The bathroom facilities are functioning properly. Cleaning supplies and chemicals are stored in locked cabinet. Medications and confidential paperwork will be stored in a locked cabinet.

The facility has fully charged fire extinguishers. Smoke alarms and Carbon Monoxide detector operational.

No citation issued.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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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