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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700993
Report Date: 01/24/2022
Date Signed: 01/24/2022 05:05:40 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: 94DATE:
01/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Jenna SilvaTIME COMPLETED:
05:12 PM
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On 1-24-22 at 3:05pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open a case management visit for an incident reported on 1-5-22. LPA met with Regional Executive Director Jenna Silva and explained the purpose of the visit. Administrator Anuradha Saini was notified of LPAs visit and gave permission for Jenna to accommodate LPA and sign in her absence. According to incident report dated 1-5-22, an encounter between two males residents was witnessed by staff on 1-4-22 which required separation of residents. LPA reviewed incident report with Regional Executive Director and interviewed Resident1 (R1) and R2. LPA interviewed RED. LPA attempted to interview Staff1 (S1) who was not available at this time. LPA also conducted a health and safety case management check. LPA observed residents and staff to be wearing masks, hand sanitizer was available at appropriate locations throughout facility. LPA was screened for COVID upon entry. Social distancing was practiced and COVID-19 signage was in place. Facility temperature was at 75*F. Facility was clean and sanitary with no foul odors. Sharp objects, toxins, and other dangerous items were inaccessible to clients in care. LPA screened facility for COVID upon entry.

Additional time is needed to complete this case management. LPA will contact Administrator at a later time for completion. An exit interview was conducted with Jenna Silva and a copy of this report was left with Jenna.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
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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