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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700642
Report Date: 01/12/2023
Date Signed: 01/12/2023 01:36:55 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/12/2023 01:36 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:SUMMERFIELD OF STOCKTON-ADULT DAY PROGRAMFACILITY NUMBER:
392700642
ADMINISTRATOR:ANDERSON, LESLIEFACILITY TYPE:
775
ADDRESS:3530 DEER PARK DRIVETELEPHONE:
(617) 796-8350
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY: 45CENSUS: 2DATE:
01/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Joseph Amantia and Hansel TaasinTIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection.

This day program operates as a Senior day center. During today's visit, there were 0 clients present. LPA inspected main assembly room, facility bathrooms. Facility is performing disaster drills as required. Fire extinguishers, carbon monoxide and smoke detectors are operational.

LPA reviewed 2 resident / participants files. Based on the file review of residents in care, LPA Johnson observed 2 of the 2 residents with current and updated information. All staff are fingerprint cleared.

Exits were observed to be accessible to clients and free from obstructions.

There were no deficiencies.

Exit interview conducted
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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