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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700647
Report Date: 10/10/2023
Date Signed: 10/10/2023 11:11:16 AM

Document Has Been Signed on 10/10/2023 11:11 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:CHOICE SLSFACILITY NUMBER:
392700647
ADMINISTRATOR:LORETTA LIVINGSTON-ANTHONYFACILITY TYPE:
735
ADDRESS:3769 POPOLO CIRTELEPHONE:
(209) 851-3925
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 4CENSUS: 4DATE:
10/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Loretta Livingston-Anthony and Flor Bustamante- Cardenas TIME COMPLETED:
11:20 PM
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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 10/10/2023 at 8:50 AM. LPA met with Loretta Livingston-Anthony and Flor Bustamante- Cardenas and stated the purpose of today’s visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate. The facility is licensed for four ambulatory clients. There are currently four client who reside at this facility. In addition, during today's annual inspection all clients were at day program.

LPA Martinez toured the facility with Flor Bustamante- Cardenas on 10/10/2023 at 10:00 AM.



LPA Martinez reviewed two employee files and two resident files, and the files were maintained. LPA Martinez reviewed two medication files, and the files were maintained. LPA Martinez inspected the first aid, which was complete. The fire extinguishers and carbon detectors were in good repair. The emergency exit gate was in good repair. The last fire drill was on September 18, 2023. Additionally, the facility had an adequate food supply, and the kitchen was sanitary. The common areas were furnished and sanitary. The facility has an area for activities, and has a public telephone. The client bedrooms and bathrooms are furnished and sanitary. The facility laundry is sanitary and laundry appliances are in good repair. The water temperature measured at 107 degrees, and the facility temperature measured at 73 degrees. Also, the facility has adequate lighting throughout the facility.

Based on this annual inspection visit 10/10/2023, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. An exit interview was held, and a copy of this report was given at the end of the visit.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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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