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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700551
Report Date: 09/27/2021
Date Signed: 09/27/2021 12:15:15 PM

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:CAMLU ASSISTED LIVINGFACILITY NUMBER:
392700551
ADMINISTRATOR:WHITTED, ALMAFACILITY TYPE:
740
ADDRESS:6037 N PERSHING AVETELEPHONE:
(209) 951-2030
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:96CENSUS: 58DATE:
09/27/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Alma WhittedTIME COMPLETED:
12:30 PM
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On 09/27/2021 at 11:15am, Licensing Program Analyst (LPA) Ashley Boothe, arrived unannounced to conduct a conduct a Health and Safety Visit. Prior to today's visit LPA spoke with Administrator regarding facility risk assessment questions who stated no staff or clients have experienced symptoms of COVID within the last 10 days. LPA met with Administrator and explained the purpose of today’s inspection. Current Census is 58. LPA observed Administrator Certificate expires on 10/10/2021.

LPA interacted with a random number of residents during this visit and observed residents engaging in communal dining. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed resident rooms, restrooms, medications room, dining room, communal areas, patio, kitchen, and staff offices. The temperature inside the facility was measured at between 70*F and 74*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*F which is not less than 105*F and not more than 120 *F. LPA observed the centrally stored medications area to be locked and inaccessible to residents.



LPA observed fire extinguisher last inspected on 8/15/2021, pull alarm system, and smoke and carbon monoxide detectors. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. LPA observed knives and toxins inaccessible to residents.

Per the California Code of Regulations, Title 22, Division 6, no deficiencies observed or cited. Exit interview held, copy of report given.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ashley BootheTELEPHONE: (916) 708-7751
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
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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