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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700993
Report Date: 09/24/2024
Date Signed: 09/24/2024 12:50:26 PM


Document Has Been Signed on 09/24/2024 12:50 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:A1 DEL MONTE STOCKTONFACILITY NUMBER:
392700993
ADMINISTRATOR:SANDEEP SAINIFACILITY TYPE:
740
ADDRESS:517 E. FULTON STREETTELEPHONE:
(209) 910-5910
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:158CENSUS: 156DATE:
09/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:LuckyTIME COMPLETED:
12:02 PM
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct a Case management. LPA met with Lucky explained the purpose of the visit.

LPA was following up on the request for an exception for R1. R1 has been under our care at the facility. This resident has recently been diagnosed with a Stage 3 wound. After careful consultation it has been determined that continuing treatment within our facility is in the residents’ best interest at this time because he stated , he is in comfortable environment and moving may cause him unnecessary stress.

We have also explained to the resident that, should the wound treatment provided by Home Health Care One or Bay Area Mobile Medical Group not prove effective, Del Monte may need to transfer him to a skilled nursing facility for more advanced care. The resident’s Power of Attorney has been made aware of this possibility and agrees with the plan of action.

Wound care will be managed by Home Health Care One’s professionals and Bay Area Mobile Medical Group who has wound specialist team and who will provide treatment on-site.

Exit interview conducted
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
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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