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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700769
Report Date: 04/21/2023
Date Signed: 04/21/2023 12:28:40 PM

Document Has Been Signed on 04/21/2023 12:28 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:DELTA MANORFACILITY NUMBER:
392700769
ADMINISTRATOR:VINCELET, CRAIGFACILITY TYPE:
735
ADDRESS:1201 W. SWAIN ROADTELEPHONE:
(805) 242-0135
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 14CENSUS: 11DATE:
04/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Craig VinceletTIME COMPLETED:
12:35 PM
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On 4/21/23 at approximately 9:40am Licensing Program Analysts (LPAs) Maja Jensen and Jennifer Fain arrived at facility to conduct a required annual inspection. LPAs met with Administrator Craig Vincelet and explained the purpose of today's visit. Craig holds current Administrator certificate # 6056012735 good through 11/18/23.

LPAs Jensen and Fain toured the facility and the grounds. The grounds were maintained and clear of debris. All exterior paths were free of obstruction. There is outdoor furniture and shade available for outdoor activities. There are no bodies of water on the premises. The interior of the facility was determined to be sanitary and free of odor. The interior walls were recently painted and are in good repair. All required resident and staff postings were observed near the main entrance of the facility. The carbon monoxide detector was determined to be in good working order. The fire extinguisher was last serviced in September of 2022 and is in compliance. The first aid kit was complete with scissors, tweezers, thermometer, various wound dressings and manual. There is emergency lighting available. The thermostat was set at 69 degrees for the comfort of residents in care. The water temperature was measured at 105 degrees. LPA Jensen observed an adequate supply of emergency food and water on site. The facility maintains an adequate supply of linens. The resident bedrooms are double occupancy. Each resident bedroom is furnished with a bed, chair, night stand, dresser and lamp. LPA Jensen observed lunch service and lunch service was as described on the posted facility menu. Food is prepared off site and brought in however the facility maintains a supply silverware and table ware as well as snacks. LPA reviewed a staff file and it was determined to be complete. LPA Jensen reviewed a resdient file and determined it to be complete. LPAs reviewed P&I funds for 3 residents and determined that all funds were accurately accounted for. LPAs interacted with residents during the course of the visit and observed client needs being met.

The facility was determined to be in substantial compliance. An exit interview was conducted and a copy of this report was given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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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