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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700885
Report Date: 12/06/2024
Date Signed: 12/08/2024 10:38:12 PM

Document Has Been Signed on 12/08/2024 10:38 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:DELTA AT THE PORTSIDEFACILITY NUMBER:
392700885
ADMINISTRATOR/
DIRECTOR:		MOMO R DUOAFACILITY TYPE:
740
ADDRESS:1950 E SONORA STREETTELEPHONE:
(209) 689-3180
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 66CENSUS: 60DATE:
12/06/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Momo DTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced Case Management annual continuation visit today to assess civil penalties for citation cited during the annual visit on 12/03/2024. LPA Johnson was met by Momo to explain the purpose of today's visit.

The LPA continued with the facility visit to ensure there are no health and safety hazards and review of fire drills and kitchen cleaning schedule and (Advisories given). Fire drill was conducted on 9/17/24.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, Type A deficiencies were observed on 12/3/2024 and cited during that visit. Civil penalties for those violations were assessed on today's annual continuation visit.

Exit interview held with the acting Administrator Momo and a copy of the report was given at the conclusion of the visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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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