<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397003946
Report Date: 06/18/2024
Date Signed: 06/18/2024 11:38:44 AM


Document Has Been Signed on 06/18/2024 11:38 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: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:
06/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Virginia CristobalTIME COMPLETED:
11:45 AM
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
On 06/18/2024 Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Virginia Cristobal and explained the purpose of the visit.

LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current and expires on 01/18/2025. The facility is licensed 6 ambulatory clients, which two can be non-ambulatory and two may be bedridden. The facility has a hospice waiver for one. There are currently three residents who reside at this facility.

The LPA Martinez toured the facility with Virginia Cristobal on 06/18/2024 at 11:00 AM.

LPA Martinez reviewed three client files and two staff files. The facility files were maintained. The facility has the required postings, which are posted throughout the facility. In addition, the facility has a locked cabinet for medications. LPA Martinez reviewed two client medication administration records (MAR), and the MARs were maintained. The facility has an infection control plan and a natural disaster plan. The last fire drill was on June 09, 2024. The facility had and adequate food supply, and the kitchen was sanitary. The facility common areas, bedrooms, bathrooms, laundry room were sanitary and furnished. The exterior of the facility was free of debris, and the emergency exit gate door is in good repair. The facility temperature measured at 75 degrees, and the facility water temperature measured at 108 degrees.

Based on this annual inspection there were no deficiencies cited. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1