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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002682
Report Date: 01/10/2025
Date Signed: 01/10/2025 07:18:39 PM

Document Has Been Signed on 01/10/2025 07:18 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SUNNY PLACE OF STOCKTONFACILITY NUMBER:
397002682
ADMINISTRATOR/
DIRECTOR:		EXPECTACIO VIERRAFACILITY TYPE:
740
ADDRESS:807 WEST SWAIN ROADTELEPHONE:
(209) 956-8677
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 18TOTAL ENROLLED CHILDREN: 0CENSUS: 12DATE:
01/10/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:07 PM
MET WITH:Gilcy Opilas.TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Albert Johnson conducted a health and safety check and to review the infection control plan. 10 hospice residents in care.

Health and Safety check included overall safety of the facility including food supply, physical plant and staffing.

(1) Invoice 500021364, Assessed on 10/09/2023 for the amount of $9,500.

Your request for the total of $9,500 to be on a payment plan has been approved and will begin on September 1st, 2024. A monthly payment of $950 will be required. Monthly payments are due by the 1st of each month for the next 10 months. Failure to make a payment by the 1st of each month will void your payment plan and the entire balance will become due and payable. Partial payments will not be accepted. This payment plan only applies to the civil penalties listed above. The final payment is due on or before May 1st, 2025.

No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes.

Exit interview conducted.
Lisa RiosTELEPHONE: (916) 969-9685
Albert JohnsonTELEPHONE: (916) 217-1390
DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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