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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700885
Report Date: 12/28/2021
Date Signed: 12/29/2021 06:59:03 AM

Document Has Been Signed on 12/29/2021 06:59 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:DELTA AT THE PORTSIDEFACILITY NUMBER:
392700885
ADMINISTRATOR:ZUBIATE, LEAH LPTFACILITY TYPE:
740
ADDRESS:1950 E SONORA STREETTELEPHONE:
(209) 689-3180
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 66CENSUS: 46DATE:
12/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Tanya Monge, Facility ManagerTIME COMPLETED:
02:45 PM
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 LPA Jacobs conducted a site inspection in regards to two incidents reports received by the Department. LPA met with Facility Manager Tanya Monge and discussed the reports. It was documented that 12 clients had a rash and itching and were seen by their doctors in person or via a televisit. Topical cream was ordered and applied and at this time there are two clients still presenting with symptoms and on-going treatment will continue for this possible scabies or lice outbreak. San Joaquin Department of Public Health has been contacted as well. LPA reviewed medical report(s) and spoke with client(s). Follow-up incident report(s) were also obtained.

In addition, a report was received with a client (C-1) left the facility without permission Tanya said the client was under supervision when he left and in addition against staff's directions. his 602 allows him to leave unassisted. LPA requested and received a copy of LIC 602.with the 624. A Police Report was filed and client was located at his mother's house.

No deficiencies identified on this visit and a copy of the report provided to T. Monge


SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2021
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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