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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397001860
Report Date: 10/19/2021
Date Signed: 10/19/2021 11:28:40 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/19/2021 11:28 AM - 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:ALAN SHORT CENTERFACILITY NUMBER:
397001860
ADMINISTRATOR:MARGARITA GARCIAFACILITY TYPE:
775
ADDRESS:928 EAST ROSE STREETTELEPHONE:
(209) 948-5759
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY: 105CENSUS: 0DATE:
10/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Pam PerezTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual inspection on this date. LPA met with Pamela Perez and explained the purpose of the visit.

There are no residents or consumer receiving on-site services.

LPA with Asst. Program Director inspected physical plant including but not limited to class rooms, Large recreation room and Staff break room. LPA observed sufficient furniture and lighting throughout the facility. The smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present

First aid kit was checked and is complete. 2 Staff and 0 Resident’s records were reviewed.

Per California Code of Regulations, Title 22 Division 6, Chapter 8 and Health and Safety Code, no deficiencies were observed during this visit.

Exit interview held.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2021
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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