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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701332
Report Date: 07/02/2024
Date Signed: 07/02/2024 03:58:16 PM

Document Has Been Signed on 07/02/2024 03:58 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/
DIRECTOR:
PELLETIER, CANDICEFACILITY TYPE:
775
ADDRESS:7209 TAM O'SHANTER DRIVETELEPHONE:
(209) 490-4666
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 150CENSUS: 118DATE:
07/02/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Candice PellietierTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 7-2-2024 at 12:40pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an post licensing inspection visit. LPA met with the program director Candice Pellietier and explained the purpose of the visit.

LPA inspected the physical plant including but not limited to the classroom areas, resident bathrooms, common areas, kitchen area, breakrooms, storage areas, office spaces, and outside of the facility to ensure compliance with Title 22 regulations. Facility is an adult day program with a current census of 118. Facility has 4 classrooms and 4 bathrooms for resident use. There are additionally 8 offices available for staff use, and a changing room. LPA also conducted the inspection using the CARE tool. The facility has an approved infection control plan in place.

Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 74*F. Client classrooms were sanitary and had the required furniture and furnishings and other supplies necessary to conduct the program. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 10-19-23. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to clients in care. Medication storage area was observed to be locked and inaccessible to clients in care. First aid kit was observed to have adequate supplies and accessible to staff.

During this inspection 5 client files and 5 staffing files were reviewed for regulatory compliance. All files contained required contents including staff training requirements. All staff noted on LIC 500 contained criminal background clearances. Client files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility’s surety bond is current and update to date per regulatory requirements. Facility does not contain any bodies of water. LPA observed personal rights posted. Facility has appropriate internet access available for resident use. {Cont. on 809C}
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 EAST
FACILITY NUMBER: 392701332
VISIT DATE: 07/02/2024
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LPA observed facility’s activity area and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts monthly fire drills. LPA requested an updated copy of LIC 308 and LIC 500.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to program director Candice Pellietier.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
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