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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700644
Report Date: 08/16/2024
Date Signed: 08/16/2024 11:03:52 AM


Document Has Been Signed on 08/16/2024 11:03 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:SUMMERFIELD OF STOCKTONFACILITY NUMBER:
392700644
ADMINISTRATOR:ANDERSON, LESLIEFACILITY TYPE:
740
ADDRESS:3530 DEER PARK DRIVETELEPHONE:
(209) 951-6500
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:60CENSUS: 55DATE:
08/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:H. TassinTIME COMPLETED:
11:34 AM
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Licensing Program Analyst (LPA) Albert Johnson arrived at the facility unannounced to complete a health, safety, and welfare visit of the clients in care. LPA met with Staff and explained the reason for the inspection.

LPA toured the facility, confirm the signs posted in the dining area and obtain statements for staff providing service to R1 on 8/10/2024. LPA inspected the physical plant, inside and out.

Facility is maintained at a comfortable temperature. Residents in care appeared to be safe and have no imminent health/safety concerns observed.


As a result of this inspection, No deficiencies were cited.

Exit interview conducted
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2024
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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