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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701216
Report Date: 05/05/2023
Date Signed: 05/05/2023 04:10:11 PM

Document Has Been Signed on 05/05/2023 04:10 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 AC/SC, 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:
05/05/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Adninisttator TROPY ASUNCION TIME COMPLETED:
04:15 PM
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On 5/5/23 at approximately 2pm LPA's Maja Jensen and Jennifer Fain arrived unannounced for a Post Licensing visit. LPA's met with Administrator Tropy Asuncion and explained the reason for today's visit. The Administrator holds a current Administrator's certificate good through November of 2023.

LPAs toured the grounds and physical plant. The facility was observed to be sanitary and free of odor. LPAs Jensen and Fain reviewed 3 of 6 resident files and determined them to be complete and in compliance. LPA Jensen reviewed P&I funds for 2 of 2 residents and determined the accounting for cash resources to be accurate. The facility maintains in excess of a 2 day supply of perishable food and a 7 day supply of non-perishable food. Knives, medications and toxins were observed to be locked and inaccessible to residents in care. The facility was observed to be a comfortable temperature and there was adequate furniture and lighting throughout. The water temperature in the bathroom was measured at 120 degrees and is in compliance. The Medication Administration Record was reviewed and determined to be complete. The first aid kit was observed to be complete and in compliance. The smoke detector and carbon monoxide detectors were tested and determined to be in working order. The facility conducts regular disaster drills and the last drill was conducted on March 6, 2023. There is an emergency supply of food and water on site. LPAs Jensen and observed signs posted throughout the facility including but not limited to personal rights, COVID mitigation, hygiene, facility sketch facility .

LPAs Jensen and Fain toured the grounds and observed the yard to be maintained and clear of debris. All Pathways were clear of obstruction. There was sufficient patio furniture observed for outdoor activities. LPAs Jensen and Fain determined that the backyard does not have a shaded area.

Deficiencies are being cited from the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties.
An exit interview was conducted and a copy of this report and appeal rights were provided.




SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Jennifer Fain
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2023
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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