<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700993
Report Date: 04/22/2022
Date Signed: 04/22/2022 04:39:59 PM


Document Has Been Signed on 04/22/2022 04:39 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: 94DATE:
04/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Jenna SilvaTIME COMPLETED:
04:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 4-22-22 at 3:05pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management regarding facility’s signal system status. LPA met with Regional Executive Director (RED) Jenna Silva and explained the purpose of the visit. Administrator Anuradha Saini was notified and gave permission for Jenna to sign in her absence and accommodate LPA. LPA observed new phones to be put in place for residents which will send a signal to care staff altering them to location of resident for purposes of addressing care needs. LPA interviewed RED during case management and conducted facility observation. Based on interviews, it was revealed that necessary parts have been delivered and a programming technician necessary to conduct programming for the new system is delayed due to internal staffing issues with supplier. LPA observed a technician in facility attempting to program pendants previously used to provide a temporary signal system before new phone system is functional. LPA also observed various residents continuing to utilize handheld bells as a temporary signal alert system. RED made aware that signal system must be in place and functional 4/29/22.

No deficiencies observed today. 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: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1