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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700993
Report Date: 04/22/2022
Date Signed: 04/22/2022 04:25:46 PM


Document Has Been Signed on 04/22/2022 04:25 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:
02:10 PM
MET WITH:Jenna SilvaTIME COMPLETED:
03:05 PM
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On 4-22-22 at 2:10pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management regarding previous eviction letters sent to Resident1(R1), R2, and R3 on 4-13-22. LPA met with Regional Executive Director (RED) Jenna Silva and explained the purpose of the visit. Administrator Anuradha Saini made aware and gave permission for Jenna to accommodate LPA and sign in her absence. LPA reviewed eviction letters and discussed supporting documentation content with RED. A review of an updated admission agreement with attachments was reviewed and discussed including policy on alcohol and drug use by residents. Recommendation from LPA to RED regarding policies was discussed. During case management visit, RED stated that previous eviction letters will be rescinded, revised, and re-issued to R1, R2, and R3 at a later date. Reporting requirements regarding eviction letters, changes in plan of operation, and admission agreements discussed with RED.

No deficiencies cited 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)
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