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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701216
Report Date: 01/25/2023
Date Signed: 01/25/2023 02:24:46 PM

Document Has Been Signed on 01/25/2023 02:24 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:LINCOLN ROAD CARE HOMEFACILITY NUMBER:
392701216
ADMINISTRATOR:ASUNCION, TROPYFACILITY TYPE:
735
ADDRESS:120 E LINCOLN ROADTELEPHONE:
(209) 915-1713
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 6CENSUS: 6DATE:
01/25/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Tropy AsuncionTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Michael Bilger, conducted an unannounced Pre-licensing visit on 1/25/23 with applicant Tropy Asuncion of Tropics Manor, Inc.. LPA arrived at facility at 12:20pm. Applicant and Administrator accompanied LPA on facility tour. This facility is currently licensed with LIC. #397001805 and applicant is seeking licensure through change of ownership process. As of today, current census is 6 residents of which 0 are Hospice, 6 are ambulatory, 0 are non ambulatory, and 0 are bedridden. The facility is a 4 bedroom, 2 bath house with a living room, dining area off the kitchen, and laundry in garage area. Residents have access to all areas. 4 of 4 staff records reviewed with criminal record clearance association in place. 6 of 6 resident files reviewed. All required contents in place. Fire clearance is approved for 6 ambulatory residents.

Upon entry, LPA’s temperature was taken and LPA signed the visitor log. LPA was screened for COVID signs and symptoms questions. Facility sketch posted and visible. Food supply is adequate with 7 days of non-perishables and 2 days of perishables on hand. All bedrooms and common areas contained appropriate furnishings. Adequate amounts of linen were in place, accessible, and located in hallway linen closet. LPA measured the hot water in the kitchen faucet and hallway bathroom and are within regulatory range of 105*F and 120*F. LPA observed kitchen knives locked and secured. Smoke detectors and carbon monoxide detectors are in good repair. COVID-19 mitigation plan and current disaster plan in place.

LPA observed medications locked and properly stored. COVID precautions in place including signage, PPE storage and 30-day supply observed. LPA observed no obstruction of emergency exits. Fire extinguisher in place in kitchen and fully charged with last inspected 4-18-22. No deficiencies cited during visit. An exit interview was conducted with Ruby Escorido and Tropy Asuncion and a copy of this report was provided to Tropy. Component III completed with Licensee and Administrator.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
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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