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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701416
Report Date: 07/09/2024
Date Signed: 07/09/2024 09:16:29 PM

Document Has Been Signed on 07/09/2024 09:16 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:ELDRED'S CARE HOME, INC.FACILITY NUMBER:
392701416
ADMINISTRATOR/
DIRECTOR:		CABRERA, DIGNAFACILITY TYPE:
735
ADDRESS:3522 WEST MENDOCINO AVETELEPHONE:
(209) 598-7588
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 4CENSUS: 0DATE:
07/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:44 AM
MET WITH:D. CabreraTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 7/9/2024 Licensing Program Analyst (LPA) Albert Johnson conducted an announced pre- licensing inspection. LPA met with Digna Cabrera and Eldred Cabrera.

Currently there are no clients at the facility. Fire clearance was granted 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, and 3 bathrooms were observed.

Hot water temperature was measured at 110 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 waived. Licensee has been in service with the department for 25 years. The land line is (209) 888-4272.

The applicant has passed the pre-licensing inspection.

LPA will notify the Central Applications Unit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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