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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700997
Report Date: 08/15/2022
Date Signed: 08/15/2022 04:34:15 PM


Document Has Been Signed on 08/15/2022 04:34 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: 48DATE:
08/15/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Diane WrightTIME COMPLETED:
04:45 PM
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On 8/15/22 at approximately 2:50pm Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a health and safety check and for follow up an informal meeting held on 7/18/22. LPA Jensen met with Administrator Diane Wright and explained the purpose of today's visit.

Upon entering the facility LPA Jensen was greeted by front desk staff who assisted the LPA using in using an automated screening device that was recently installed. The screening device logged responses to all COVID-19 screening questions and also logged temperature taken. LPA Jensen toured the facility and the grounds, including but not limited dining room, hallways, resident rooms and activity rooms. LPA observed that all common areas were free of debris and hazardous items. The sliding door to next to the elevator located between the two wings of the facility was observed to be locked and signs were posted indicating there was no access to the roof. The laundry room was observed to be free of debris and toxins. The stair wells located on the end of each wing was observed to be free of obstruction or hazards. The grounds were observed to be maintained and free of obstruction. The facility is currently using portable air conditioning units with a separate air conditioning unit located in each resident room and a larger unit in the common areas. LPA Jensen interviewed two residents who confirmed their respective rooms are maintained at a comfortable temperature.

No deficiencies are being cited as a result of today's visit. An exit interview was conducted and a copy of this report was given to the administrator.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2022
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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