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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700997
Report Date: 03/16/2022
Date Signed: 03/16/2022 03:27:58 PM


Document Has Been Signed on 03/16/2022 03:27 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:WHITTED, ALMAFACILITY TYPE:
740
ADDRESS:6037 N. PERSHING AVENUETELEPHONE:
(209) 951-2030
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:160CENSUS: DATE:
03/16/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Alma WhittedTIME COMPLETED:
11:16 AM
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Licensing Program Analysts (LPAs) Maja Jensen and Avelina Martinez arrived unannounced to conduct a case management visit on 3/16/22 at 9:40 am. LPAs were granted access to the facility and screened for COVID upon entering. LPAs met with Administrator Alma Whited and explained the purpose of today's visit.

LPAs Maja Jensen and Avelina Martinez conducted today's case management due to concerns over deliveries not being received. LPAs Maja Jensen and Avelina Martinez conducted interviews at the facility to confirm the delivery procedures with staff and also verified that the issue had been resolved.

As a result of today's visit no Title 22 deficiencies were observed and a copy of this report was given to the facility administrator.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2022
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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