<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701262
Report Date: 05/09/2023
Date Signed: 05/09/2023 12:09:54 PM

Document Has Been Signed on 05/09/2023 12:09 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:ABLE ADULT CARE FACILITYFACILITY NUMBER:
392701262
ADMINISTRATOR:AUGUSTUS,BLESSING;MUSTAPHAFACILITY TYPE:
735
ADDRESS:439 W. 3RD STREETTELEPHONE:
(209) 565-6190
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 4CENSUS: 0DATE:
05/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH: Abideen Mustapha and Blessing Augustus TIME COMPLETED:
12:18 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Albert Johnson arrived announced to complete a pre licensing inspection. LPA met with Abideen Mustapha and Blessing Augustus.

Currently there are no clients at the facility. Fire clearance was granted on 2/07/23 for 4 Non-ambulatory clients.

Facility was inspected both indoors and outdoors. LPA inspected proposed bedrooms, bathrooms, kitchen, garage, and common areas. Outdoor exits are clear and accessible. There one floors to this facility. 4 resident bedrooms, a staff/meeting room and 2 bathrooms were observed.

Hot water temperature was measured at 105.5 degrees. Smoke detectors and carbon monoxide detectors were checked and operational. Fire extinguisher indicator revealed a full charge. Kitchen is clean sanitary, and in good repair. There will be a locked areas for cleaning supplies, sharps, medications and toxins.

Component III was completed. The land line is (209) 565-6190

The applicant has passed the pre-licensing inspection.

LPA will notify the Central Applications Unit.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1