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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700642
Report Date: 03/07/2024
Date Signed: 03/07/2024 02:32:34 PM

Document Has Been Signed on 03/07/2024 02:32 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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:
03/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Hansel TassinTIME COMPLETED:
02:37 PM
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On 3/7/2024 Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. The inspection began at approximately 1:00pm.

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: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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