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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700993
Report Date: 11/04/2022
Date Signed: 11/04/2022 04:44:20 PM


Document Has Been Signed on 11/04/2022 04:44 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: 100DATE:
11/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Anuradha SainiTIME COMPLETED:
04:30 PM
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On 11-4-22 at 3:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit for health and safety. LPA met with Administrator Anuradha Saini and explained the purpose of the visit. LPA interviewed Administrator and staff1 (S1). LPA also reviewed incident reports for resident1 (R1) dated 10-16-22 and additional care notes for R1. Based on interview and record reviews, it was determined that R1 was admitted to the hospital on 10-16-22 due to thrombosis. On 10-20-22, facility received information from hospital that R1 was diagnosed with scabies on 10-19-22. Based on interview, it was revealed that no further cases of scabies have been reported or diagnosed within facility at this time, and facility continues to take necessary precautions including regular monitoring of residents for signs and symptoms of scabies since learning of R1’s diagnosis. Incident on 10-16-22 was reported per regulatory requirements.

No citations issued today as a result of this case management. An exit interview was conducted with Anuradha Saini and a copy of this report was left with Anuradha.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022
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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