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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700993
Report Date: 03/14/2022
Date Signed: 03/14/2022 05:15:15 PM


Document Has Been Signed on 03/14/2022 05:15 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: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: 98DATE:
03/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jenna SilvaTIME COMPLETED:
01:00 PM
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On 3-14-22 at 11:30am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding potential room changes. LPA met with Administrator Anuradha Saini and explained the purpose of the visit. Regional Executive Director Jenna Silva was present and was given permission by Anuradha to sign on her behalf and accommodate LPA. LPA interviewed Administrator and Regional Executive Director. LPA also reviewed notices of potential room changes given to resident1(R1) and R2 . LPA also interviewed R1 and R2 and reviewed additional notices given to other residents in care. Based on interviews and record reviews, it was determined that facility is planning to convert the downstairs unit to memory care and hospice. A notice dated 2-3-22 was given to residents in care stating the intention of potential room changes due to this conversion and the reason for the conversion. It was further discovered that total bed capacity will not change as a result of this conversion, however, residents currently occupying a downstairs unit may be relocated upstairs, given the option to rent the entire room out at a private room rate, or opt to have a roommate occupying the shared portion of said room. Contents of the letter and potential revisions were discussed with regional executive director and resident rights were reviewed. Additional processes such as the required LIC 200 form and fire clearance requirements were discussed. At this time, facility does not have a firm date of when the conversion will take place and has given pre-emptive notices to residents to make them aware of the future plans for the conversion.

No deficiencies were cited. An exit interview was conducted with Jenna Silva and a copy of this report was given to Jenna

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
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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