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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397001860
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:32:22 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/26/2022 12:32 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
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: 21DATE:
10/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:M. GarciaTIME COMPLETED:
12:13 PM
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Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual inspection on this date. LPA met with M.Garcia and explained the purpose of the visit.

LPA inspected physical plant including but not limited to (5) class rooms, Large recreation room and Staff break room. LPA observed sufficient furniture and lighting throughout the program. Hot water temperature was measured at 120 degrees Fahrenheit in the bathroom , which is within the required range of 105 to 120 degrees. The smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present

First aid kit was checked and is complete. The last fire drill was conducted on 07/26/2022. 4 Staff and 10 Resident’s records were reviewed. The program has recently re-opened and has not up-dated the IPP's for each consumer or the staff files to included recently completed first aid certification.

Per California Code of Regulations, Title 22 Division 6, Chapter 8 and Health and Safety Code, No Deficiencies were cited during this visit. (Advisories given)

Exit interview held and a report given at the conclusion of the inspection.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
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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