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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701416
Report Date: 10/01/2024
Date Signed: 10/08/2024 12:46:59 PM

Document Has Been Signed on 10/08/2024 12:46 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:
10/01/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:E. Cabrera TIME VISIT/
INSPECTION COMPLETED:
11:51 AM
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Licensing Program Analyst (LPA) Albert Johnson met with Licensee to conduct Post Licensing Inspection. Administrator/Licensee assisted LPA with inspection.

LPA inspected Physical Plant, Common Areas, Bedrooms, Bathrooms, Kitchen, Food Service, Medication and Records. Common area was clean and in good repair. All bedrooms had required furniture, bedding and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Facility has required (7) seven day non-perishable and (2) day perishable supply of food. Centrally stored medication was properly stored and locked away.

Administrator certificate is current. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured 110.5 degrees. All employees requiring background checks are cleared. Facility has required liability insurance policy. All required postings are displayed within facility.

As a result of this inspection, No deficiencies were cited, per Title 22 Regulations, Division 6.

Exit interview with Administrator and report provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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