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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701033
Report Date: 11/12/2021
Date Signed: 11/12/2021 12:07:19 PM

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:ST. RITA CARE HOMEFACILITY NUMBER:
392701033
ADMINISTRATOR:TALONGWA, CATHERINEFACILITY TYPE:
740
ADDRESS:3478 LADD TRACT CT.TELEPHONE:
(650) 465-2526
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 2DATE:
11/12/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:C TalongwaTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Albert Johnson met with staff to conduct Post Licensing Inspection. LPA advised staff to notify Administrator of LPA presence in the facility and purpose of inspection. Administrator arrived at facility to assist LPA with inspection.

LPA inspected Physical Plant, Common Areas, Bedrooms, Bathrooms, Kitchen, Food Service, Medication and Records. Common area was clean and in good repair. All bedrooms had required furniture, bedding and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Facility has required (7) seven day non-perishable and (2) day perishable supply of food. Centrally stored medication was properly stored and locked away. LPA reviewed (2) resident files.

Administrator certificate is current. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured 119.5 degrees. All employees requiring background checks are cleared. Facility has required liability insurance policy. All required postings are displayed within facility.

As a result of this inspection, No deficiencies were cited, per Title 22 Regulations, Division 6.

Exit interview with Administrator and report given
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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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