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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002220
Report Date: 10/20/2022
Date Signed: 10/21/2022 09:22:15 AM

Document Has Been Signed on 10/21/2022 09:22 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:PERSON CENTERED SERVICES, INC #2FACILITY NUMBER:
397002220
ADMINISTRATOR:ANN MARRIOTTFACILITY TYPE:
775
ADDRESS:4155 N. EL DORADO STREETTELEPHONE:
(209) 466-2448
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 135CENSUS: 71DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Program Manager Justin Huiras TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an annual/required inspection. LPA met with Program Manager Justin Huiras and explained the reason for the visit. Census 71

LPA Lund and Program Manager Justin Huiras and toured/inspected the day program inside and outside to ensure the safety of the clients. The facility has private restrooms set up to meet clients staffing level needs and abilities. LPA observed tables and chairs to serve the capacity and promote social distancing and disinfectant available for use. LPA observed all areas to be clean and in good repair. The facility cleans and disinfects surfaces in the morning, in-between pods of clients and at the end of the day. The temperature inside the facility was measured between at 75*F and 76*F which is within the required range of 68*F and 85*F. LPA observed first aid kits in each class room and the main office was found in compliance. LPA observed a pull alarm system, fire extinguishers inspected on 6/8/2022, smoke and carbon monoxide detectors, central heating and air in the facility.

Per the California Code of Regulations, Title 22, no deficiencies observed or cited. Exit interview held with Program Manager Justin Huiras, and copy of report provided.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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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