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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701217
Report Date: 02/26/2025
Date Signed: 02/26/2025 02:56:23 PM

Document Has Been Signed on 02/26/2025 02:56 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EUCLID RESIDENTIAL CAREFACILITY NUMBER:
392701217
ADMINISTRATOR/
DIRECTOR:		ASUNCION, TROPYFACILITY TYPE:
735
ADDRESS:2429 W EUCLID AVETELEPHONE:
(209) 915-1713
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 4CENSUS: 4DATE:
02/26/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Ruby Ana EscoridoTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. The LPA met with Staff. The facility is an adult residential facility funded by Valley Mountain Regional Center with a current census of 4. Facility has 4 bedrooms and 3 bathrooms. Three bedrooms are for resident use. Facility has a formal dining area and a formal living room. LPA and Staff inspected the physical plant to ensure the health and safety of the clients in care. LPA inspected the facility with Staff including but not limited to the kitchen area, resident rooms, bathrooms, dining room, and storage areas. The facility had the required carbon monoxide detectors. The facility is free of odor, however the facility had multiple building and grounds violations: the front and back yards are in need of service the grass is over grown and needs trimming and edging, there is debris on the back area on the patio, there is debris on the back fence area by the storage shed, the shed is open and needs cleaning or organizing, the pool that is fenced needs draining and covering, the shower needs a drain plug, the floor is cracked in the residents bathroom, the bathroom needs a screen for the window above the shower and the floor heater vent is bent with sharp edges. LPA observed sufficient lighting throughout the facility. Fire extinguishers and smoke detectors are current and in compliance with fire safety. Fire drill was conducted on 1/5/2025. LPA reviewed four (4) client files and two (2) staff files, including criminal record clearances. LPA observed centrally stored medications locked in then medication room. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed resident and staff files, and interviewed both. All staff were cleared and associated to the facility. First aid kit was checked and is complete. Citation given. Exit interview conducted.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2025
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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Document Has Been Signed on 02/26/2025 02:56 PM - It Cannot Be Edited


Created By: Albert Johnson On 02/26/2025 at 01:49 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: EUCLID RESIDENTIAL CARE
FACILITY NUMBER: 392701217

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2025
Section Cited
CCR
80087(a)

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Buildings and Grounds. The facility shall be kept clean, sanitary and in good repair at all times. This requirement was not met as evidenced by: the front and back yards are in need of service the grass is over grown and needs trimming and edging,
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The facility will clean repair or replace any items identified in the report and send pictures by 3/7/2025. additionally LPA will return at a later date to clear deficiencies
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 there is debris on the back area on the patio, there is debris on the back fence area by the storage shed, the shed is open and needs cleaning or organizing, the pool that is fenced needs draining and covering, the shower needs a drain plug, the floor is cracked in the residents bathroom, the bathroom needs a screen for the window above the shower and the floor heater vent is bent with sharp edges. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Albert Johnson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
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