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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701332
Report Date: 03/05/2024
Date Signed: 03/05/2024 04:07:10 PM

Document Has Been Signed on 03/05/2024 04:07 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:CENTRAL VALLEY TRAINING CENTER STOCKTON EASTFACILITY NUMBER:
392701332
ADMINISTRATOR:PELLETIER, CANDICEFACILITY TYPE:
735
ADDRESS:7209 TAM O'SHANTER DRIVETELEPHONE:
(209) 490-4666
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 150CENSUS: 0DATE:
03/05/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Candice PelletierTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michael Bilger conducted a pre-licensing visit to this facility on 3-5-24 at 2:00pm and was met by the Applicants Candice Pelletier and Jennifer Jones. A brief interview was conducted with the Applicants. An approved infection control plan is in place for this facility.
It was learned that this facility will be licensed as an Adult Day Program to serve up to 150 clients of which 20 may be non-ambulatory. This Applicant is also seeking new licensure as a result of a change in location. There were no clients present during today's pre-licensing visit. A tour of the facility was conducted by LPA.
Common areas and other areas intended for resident use including classrooms and bathrooms were toured and observed to be adequately furnished and maintained in compliance at this time. Exit signs are in place as appropriate. Fire extinguishers are in place and fully charged. Facility map indicating emergency exits posted in appropriate locations. Interior of facility presents as clean and sanitary with no obvious stains on floors and walls. Additionally, LPA did not observe any foul odors throughout.
Kitchen area was toured and observed to be clean and sanitary. Kitchen area contains a stove and refrigerator, and additional seating space. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. Medication storage area was observed to contain a locking mechanism. First aid kit was observed to be present and contained all required components at this time.
A tour of the facility bathrooms was conducted. Hot water temperatures were taken and measured within the allowed range of 105-120 degrees. A sufficient amount of supplies for various activity programs was observed to be in place and ready for use. Facility has a designated staff break room.
A tour of the exterior grounds was conducted. LPA observed sufficient space for safe and adequate transportation needs. No obstructions of fire exits noted. This facility has been found to be in compliance at this time.
There were no deficiencies observed during today's Pre-licensing visit. Component III completed with applicant during visit. Exit Interview conducted with Candice Pelletier. A copy of this report was left with the Applicant
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
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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