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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700997
Report Date: 07/18/2022
Date Signed: 07/18/2022 04:05:41 PM


Document Has Been Signed on 07/18/2022 04:05 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:CAMLU ASSISTED LIVINGFACILITY NUMBER:
392700997
ADMINISTRATOR:DIANE WRIGHTFACILITY TYPE:
740
ADDRESS:6037 N. PERSHING AVENUETELEPHONE:
(209) 951-2030
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:160CENSUS: DATE:
07/18/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Chris Coulter, Diane Wright, Zachary ButcherTIME COMPLETED:
03:45 PM
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An Informal Conference was conducted today, 07/18/2022, via Microsoft Teams. The purpose of the Informal Conference was to discuss the facilities compliance with Title 22 Regulations as a result of deficiencies cited during complaint investigations and site visits on 1/24/22, 2/25/22, 3/30/22 and 4/15/22. Present at today's Informal Conference were: Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Maja Jensen and Licensees, Chris Coulter and Administrator Diane Wright. The informal conference process was explained during this meeting.

The following issues were discussed during the informal conference:
· COVID-19 Prevention
· Storage of toxins and hazardous objects
· Sufficient Staffing
· Pest Infestation
· Building and grounds maintenance.
· Alert Notification System (Call Button System)

Licensees stated they will do the following to achieve continued and substantial compliance:
· Submit new LIC 500 personnel report with updated staff schedules by 7/25/22. Facility has current contracts with staffing agencies that it is not utilizing as they are fully staffed at this time
· Adhere to COVID-19 screening procedures and Infection Control Plans. A calendar of training of staff and refresher courses will be submitted by 7/25/22

Continued on LIC 809C....
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2022
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: CAMLU ASSISTED LIVING
FACILITY NUMBER: 392700997
VISIT DATE: 07/18/2022
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· Maintain regularly scheduled pest control services. Ecolab reports will be submitted via email by 7/25/22
· Maintain a clean, safe and sanitary building and grounds. An update to the HVAC plan will be submitted via email by 7/25/22

Licensees were offered an opportunity to participate in Department's Technical support Program.

No deficiencies were cited from the California Code of Regulations, Title 22, Division 6 as a result of today's meeting

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC809 (FAS) - (06/04)
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