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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397003946
Report Date: 04/19/2022
Date Signed: 04/19/2022 04:49:50 PM


Document Has Been Signed on 04/19/2022 04:49 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:ALCOR GUEST HOME IIFACILITY NUMBER:
397003946
ADMINISTRATOR:POIER, CORAZONFACILITY TYPE:
740
ADDRESS:5555 PATTI LYNN WAYTELEPHONE:
(209) 478-9804
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:6CENSUS: 3DATE:
04/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Corazon Poier, LicenseeTIME COMPLETED:
03:35 PM
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On 04/19/2022 at At 9:25 am, Licensing Program Analysts (LPAs) T. White and R. Campbell arrived unannounced to conduct a Required 1-year annual inspection. LPAs met with Licensee, Corazon Poier and explained the purpose of today’s inspection. LPAs were allowed entry into the facility that is licensed to serve a total capacity of 6 residents.

LPAs toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 107 degrees Fahrenheit. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods.

Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on February 07, 2022. Emergency Disaster Plan was last posted on 05/14/2021. First aid kit was observed to be complete. Fire drill was last conducted on 03/07/2022. LPAs reviewed 3 resident files and 2 staff record files.

No deficiencies cited during inspection.

Exit interview conducted with Licensee and Caregiver. A copy of report given.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Treana WhiteTELEPHONE: (510) 566-9342
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022
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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