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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397001860
Report Date: 11/21/2024
Date Signed: 11/21/2024 01:09:30 PM

Document Has Been Signed on 11/21/2024 01:09 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:ALAN SHORT CENTERFACILITY NUMBER:
397001860
ADMINISTRATOR/
DIRECTOR:
MARGARITA GARCIAFACILITY TYPE:
775
ADDRESS:928 EAST ROSE STREETTELEPHONE:
(209) 948-5759
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY: 105CENSUS: 43DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Pamela PerezTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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On 11-21-24 at 10:20am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the assistant program director Pamela Perez and explained the purpose of the visit. Program Director Margarita Garcia was also present.

LPA inspected the physical plant including but not limited to the kitchen area, cafeteria, client classrooms, client bathrooms, laundry area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is an adult day program with a current census of 43. Facility has 8 classrooms for client use. 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 75*F. Resident classrooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 7-24-24. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff.

During this inspection 5 resident files and 5 staffing files were reviewed for regulatory compliance. All staff files contained required regulatory contents. All staff files reviewed contained criminal background clearances. LPA completed 3 resident interviews and 3 staff interviews. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility’s surety bond is updated. Facility does not contain any bodies of water. {Cont.. on 809C}
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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: ALAN SHORT CENTER
FACILITY NUMBER: 397001860
VISIT DATE: 11/21/2024
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LPA observed personal rights posted. Facility has appropriate internet access available for resident use. LPA observed 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, deficiencies were observed during this visit and noted on LIC 809D. Exit interview was held and a report was given to Pamela Perez. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
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