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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700978
Report Date: 10/26/2021
Date Signed: 10/26/2021 01:21:40 PM

Document Has Been Signed on 10/26/2021 01:21 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:QUARTER HOUSE, LLCFACILITY NUMBER:
392700978
ADMINISTRATOR:CAMPBELL, SCOTT R.FACILITY TYPE:
735
ADDRESS:2111 LIVINGSTON LANETELEPHONE:
(209) 351-4808
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 4CENSUS: 4DATE:
10/26/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Heather Mobley, AdministratorTIME COMPLETED:
01:21 PM
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On 10-26-21 at 10:12pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit for an incident reported by facility on 9-27-21 involving Resident1 (R1) and potential mishandling of funds. Incident report stated that during a team meeting at facility, R1 stated that she believed a friend used R1's name to apply for COVID relief funds through a utility company. LPA interviewed Administrator during today's visit and reviewed R1s Individual Program Plan (IPP). LPA also interviewed R1 via phone. Based on interviews and documentation reviewed it was determined that facility reported incident timely and made efforts towards protecting R1s personal and financial information. LPA observed all resident charts are secured and inaccessible to unauthorized persons. Based on interviews and record review it was determined that R1 gave access of financial information to friend voluntarily and is capable of managing own financial affairs.

Based on interviews and documentation reviewed, the department has closed this case management at this time. There are no deficiencies issued during today's visit.

An exit interview as conducted with Administrator Heather Mobley and a copy of this report was left with Heather.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2021
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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