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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002682
Report Date: 07/03/2023
Date Signed: 07/03/2023 04:18:49 PM


Document Has Been Signed on 07/03/2023 04:18 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:SUNNY PLACE OF STOCKTONFACILITY NUMBER:
397002682
ADMINISTRATOR:EXPECTACIO VIERRAFACILITY TYPE:
740
ADDRESS:807 WEST SWAIN ROADTELEPHONE:
(209) 956-8677
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:18CENSUS: 10DATE:
07/03/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Expectacion VierraTIME COMPLETED:
04:25 PM
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On 7/3/23 at approximately 2:15pm Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a quarterly health and safety check. LPA Jensen met with Licensee Expectacion (Espie) Vierra and explained the purpose of today's visit.

LPA Jensen checked the food supply and determined there was in excess of a 2 day supply of perishable food and a 7 day supply of non-perishable food. The facility has permanently removed hot dogs from the menu. LPA Jensen determined the posted menu accurately reflected what was served for meals on this day.

LPA Jensen reviewed 5 of 10 resident files. 5 of 5 resident files had updated LIC 602's and Needs and Service Plans. 4 of 5 residents have special diets. LPA Jensen provided technical assistance regarding serving the needs of residents with special diets.

LPA Jensen observed 10 of 10 residents and all residents appeared to have their needs met.

The following trainings have been conducted in 2023:
Medications and Care Plans conducted by Wellbe Health
Fire and Disaster Emergency Information in-service
Aspiration, Dysphagia, Bedsore Prevention and Pain Management in-service
Narcotics and PRN Medication in-service
Swallowing and Choking by Infinity Hospice

LPA Jensen requested an LIC 308 and receieved an updated LIC 308 listing Eleneor Laurora as designee.

No deficiencies were cited as a result of this visit. An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2023
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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