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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700551
Report Date: 06/23/2021
Date Signed: 06/23/2021 02:42:00 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: 60DATE:
06/23/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Alma WhittedTIME COMPLETED:
02:45 PM
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On 06/23/2021 at 11:30am, Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a visit in accordance with the stipulation order effective July 2, 2019. LPA met with Administrator and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 96 clients. Current Census is 60.

The physical plant was toured inside to ensure the safety of the residents. LPA observed resident rooms, restrooms, medications room, dining room, and staff office. LPA reviewed Incident Reports submitted to the Regional Office found to be compliance at this time. LPA reviewed four personnel files found to be compliance at this time. LPA observed that medications and any other toxic products are properly stored and kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. LPA observed the facility is clean, safe, sanitary and but not in good repair at this time in that the central air conditioning system is not in working order. Reasonable accommodations have been made by purchasing individual units for all resident rooms and common areas. LPA measure temperature to be at 78*F within regulatory range of 68*F to 85*F. LPA reviewed two resident needs and services plans and care plans for restricted health conditions to be updated on 5/4/2021, and 6/22/2021. LPA reviewed monthly training logs including mental health assessments, client behaviors, and medication. LPA observed last training completed on 4/30/2021 and 6/4/2021. Next training's scheduled for 6/25/2021 and 7/3/2021.

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: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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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