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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700993
Report Date: 11/30/2021
Date Signed: 11/30/2021 03:07:49 PM

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:A1 DEL MONTE STOCKTONFACILITY NUMBER:
392700993
ADMINISTRATOR:SAINI, ANURADHAFACILITY TYPE:
740
ADDRESS:517 E. FULTON STREETTELEPHONE:
(209) 910-5910
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:158CENSUS: 90DATE:
11/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:11 PM
MET WITH:Ian PhitnoukanhTIME COMPLETED:
03:15 PM
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On 11-30-21 at 1:10pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit due to a recently expressed concern regarding resident rights. LPA met with resident care coordinator (RCC) Ian Phitnoukanh and explained the purpose of the visit. Administrator Anuradha Saini was notified of LPAs visit and gave permission for Ian to sign in her absence.

LPA interviewed Resident1 (R1) and R2. LPA also interviewed RCC. Based on these interviews it was determined that R1 and R2 have been sustaining a mutual friendship within the facility including private visitations, meals together, and attending activities together. It was further determined that R1 and R2 are able to interact with one another without interference of facility staff.

Based on interviews conducted, R1 and R2 are continuing to maintain a mutual friendship without infringement on resident rights.

As a result of today's visit, no deficiencies are cited today. An exit interview was conducted with Ian Phitnoukanh and a copy of this report was left with Ian.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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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