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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701033
Report Date: 07/14/2022
Date Signed: 07/14/2022 04:08:56 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/14/2022 04:08 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: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: 3DATE:
07/14/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:19 PM
MET WITH:Olivia KellyTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced Case Management annual continuation visit to day at the facility to continue with the Annual visit initiated on 6/23/2022. LPA Johnson was met by Staff Olivia Kelly.

The LPA continued with facility visit to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The LPA reviewed resident records and staff records and staff training records. Medications and medication procedures were also reviewed.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, No deficiencies were cited during this visit.


Exit interview held.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
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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