397002682-7-18-2024-27-AS-AJON-D7ALKV-20240718085010

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 397002682
Report Date: 07/17/2024
Date Signed: 07/18/2024 08:50:25 AM

Document Has Been Signed on 07/18/2024 08:50 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 STOCKTON		FACILITY NUMBER:	397002682
ADMINISTRATOR:	EXPECTACIO VIERRA		FACILITY TYPE:	740
ADDRESS:	807 WEST SWAIN ROAD		TELEPHONE:	(209) 956-8677
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	18	CENSUS: 12	DATE:	07/17/2024
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	E. Vierra		TIME COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An office meeting was held on 7/10/24 at 3pm on a Microsoft Teams Meeting video conferencing system review the stipulation adopted on 7/10/2024 and the next steps. This Stipulation shall be posted in a conspicuous place at the facility for the duration of the probationary period. The following were in attendance: Regional Manager Stephenie Doub, Licensing Program Manager Lisa Rios, LPA Albert Johnson, Administrator Expectacion Vierra, Asst. Administrator Gilcy Opilas. The Stipulation were reviewed with Representatives, Administrators, and Licensees who expressed their understanding. Items discussed at the meeting included, but not limited to: Stipulation contents: · Findings · Revocation of Licenses and Administrator Certificates/License Application Denials – Not Stayed · Exclusions- Not Stayed · Revocations of Licenses and Administrator Certificates/License Application Denials -Stayed with Probation · Stay of Revocation of Licenses and Administrator Certificate and Exclusion to Facilitate Sale of Facilities

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

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: SUNNY PLACE OF STOCKTON	FACILITY NUMBER: 397002682
	VISIT DATE: 07/17/2024

NARRATIVE

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Future Application for License, Registration, Certification or Approval
· Licensure, Certification or Approval; Application Denial, Tolling of Probationary Period
· Completion of Probation
· Violation of Stipulation Term
· Department's Authority
· Monitoring Fee
· Waiver of Hearing Rights; Waiver of Appeal/Modification Rights/Waiver of Claims
· Severable terms
· Public Records
· Signatures
· Counterparts
· Effective Date: (7/10/2024 – 7/10/2026)
· No Oral Modification

The Licensees/Respondents/Representatives stated they would abide by the following:
· Abide by the contents/terms of the Stipulation (submit all documents timely)
· Operate the facility in strict compliance with the regulations and statues governing the operation of a residential care facility for the elderly.

CCLD will do the following:
· Increase monitoring

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations cited during this visit. An exit interview was conducted, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert Johnson	TELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

LIC809 (FAS) - (06/04)

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