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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002682
Report Date: 10/31/2023
Date Signed: 10/31/2023 04:07:30 PM


Document Has Been Signed on 10/31/2023 04:07 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: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: DATE:
10/31/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Expectacion VierraTIME COMPLETED:
04:10 PM
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On 10/31/23 at approximately 3:10pm, Licensing Program Analyst (LPA) Jensen arrived at facility unannounced to conduct a visit to ensure compliance with Health and Safety Code (HSC) 1569.38 - Posting of Licensing Reports - Disclosure to new Residents. LPA Jensen met with Administrator Expectacion Vierra and explained the purpose of today's visit.

LPA Jensen observed the Accusation posted in the main lobby. The posting was displayed in a location easily viewable by residents and visitors. LPA Jensen interviewed Expectacion Vierra and she confirmed that written notice was handed to existing residents within or on the tenth day after receiving the notification and mailed by US Post to responsible parties. LPA Jensen was given a blank sample notice that was distributed.

Based on LPA Jensen's observation and interview the facility is in compliance with HSC 1569.38. In addition, the Department will be contacting the residents or responsible parties to verify that notice was received.

An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2023
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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