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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700997
Report Date: 03/19/2024
Date Signed: 03/19/2024 02:45:59 PM


Document Has Been Signed on 03/19/2024 02:45 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:CAMLU ASSISTED LIVINGFACILITY NUMBER:
392700997
ADMINISTRATOR:CHANTLLE HUDSONFACILITY TYPE:
740
ADDRESS:6037 N. PERSHING AVENUETELEPHONE:
(209) 951-2030
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:160CENSUS: 50DATE:
03/19/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:33 PM
MET WITH:Grecthen M. TIME COMPLETED:
03:04 PM
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On 3/19/24, Licensing Program Analyst (LPA) Albert Johnson arrived at facility unannounced to clear citations for a case management visit that was completed on 2/1/2024. LPA Johnson met with Gretchen Monares and explained the purpose of today's visit.

The following deficiencies, initially cited during a visit on 02/01/2024, have been cleared:

Section Cited: 87303(a)
Plan of Correction:
The facility will repair or replace the Unit for air-conditioning and heating by the POC date or provide the department with a plan to repair or replace the unit by 2/15/2024.		Corrections:
Cleared By Visit		Clearance Date:
03/19/2024
LPA was able to confirm that the facility has established a plan of action to completed the HVAC system. The completion date is to be determined and a copy of the permits and floor plan will be submitted to the department before construction starts.

Section Cited: 87463(a)
Plan of Correction:
The Administrator will update any and all service plans for any resident that is being billed for services not identified in their pre-appraisal or their current service plan. Proof of this will be submitted to licensing by 2/15/2024		Corrections:
Cleared By Visit		Clearance Date:
03/19/2024
LPA was able to review service plans for three residents to confirm the updated information is in place.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024
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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