<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700644
Report Date: 03/18/2025
Date Signed: 03/18/2025 12:24:55 PM

Document Has Been Signed on 03/18/2025 12:24 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 STOCKTONFACILITY NUMBER:
392700644
ADMINISTRATOR/
DIRECTOR:
ANDERSON, LESLIEFACILITY TYPE:
740
ADDRESS:3530 DEER PARK DRIVETELEPHONE:
(209) 951-6500
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 54DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:04 AM
MET WITH:L. AndersonTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst Albert Johnson arrived unannounced to conduct an Annual inspection. Currently 54 clients reside at the assisted living facility (all dementia). Facility has a fire clearance granted for 60 non-ambulatory residents with up to 12 receiving hospice services.

LPA inspected the physical plant with including but not limited to the kitchen, bedrooms for residents, resident bathrooms, laundry area and general assembly area. LPA observed the facility to be free of odor and clean. The facility has a fire door located in the Ivy cottage that is in need of replacement and a heater booster for the dishwasher in the main kitchen that needs fixing. Advisory given. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 110.9 degrees Fahrenheit, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety. Fire drill was conducted on 1/2025 as required.

LPA observed centrally stored medications and toxins are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 12 resident and 6 staff files, including criminal record clearances. All staff are fingerprint cleared and associated to the facility.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, No citations given. Exit interview held and a copy of report given with appeal right
Lisa RiosTELEPHONE: (916) 969-9685
Albert JohnsonTELEPHONE: (916) 217-1390
DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1