Community Care Licensing

FACILITY NAME:	BUENA VIDA CARE HOME II		FACILITY NUMBER:	392700932
ADMINISTRATOR:	LADION, PIERRE J.		FACILITY TYPE:	735
ADDRESS:	1143 LUNA LANE		TELEPHONE:	(209) 464-1668
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95206
CAPACITY: 4		CENSUS: 4	DATE:	07/24/2023
TYPE OF VISIT:	Required - 1 Year	ANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	P. Ladion		TIME COMPLETED:	02:45 PM

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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an POC/annual inspection. The following deficiencies, initially cited during a visit on 06/19/2023, have been cleared: Section Cited: 87411(f) Date Due: 06/20/2023 Plan of Correction: Administrator to provide a health screening/TB results for staff (S1) by POC date 6/20/2023 Corrections: Cleared By Visit Clearance Date: 07/24/2023 This citation was given on the Post Licensing visit conducted on 6/19/2023. Exit interview

SUPERVISORS NAME: Stephenie Doub LICENSING EVALUATOR NAME: Albert Johnson LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2023