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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002682
Report Date: 03/12/2024
Date Signed: 03/15/2024 11:11:02 AM


Document Has Been Signed on 03/15/2024 11:11 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
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: 12DATE:
03/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Expectacio VierraTIME COMPLETED:
02:45 PM
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On 3/12/2024, Licensing Program Analyst (LPA) Albert Johnson arrived at this facility unannounced to conduct an annual inspection visit. LPA met with care staff and Administrator Expectacio Vierra and explained the purpose of the visit.

LPA Johnson inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside yard of the facility to ensure compliance with Title 22 regulations. Facility is an 18-bed facility with a current census of 12. Facility has 9 shared bedrooms. There is an entry way and small lobby area. Facility has a separate dining room and activities room. Facility also has a hair salon and outside courtyard area for visitations. LPA also conducted the infection control domain tool. Water temperature reads 112.5 F in the bathroom. LPA observed the facility to have adequate food supply. Resident rooms 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 4/20/23. Facility has a built in sprinkler and smoke and heat detectors.

LPA Johnson toured the grounds and observed all pathways were clear. There is sufficient outdoor furniture for residents to participate in outdoor activities.

No deficiencies are being cited from the California Code of Regulations (CCR) Title 22, Division 6.
An exit interview was conducted and a copy of this report were given.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
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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