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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397003946
Report Date: 05/05/2023
Date Signed: 07/06/2023 01:11:14 PM


Document Has Been Signed on 07/06/2023 01:11 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 AC/SC, 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: 2DATE:
05/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Virginia Cristobal, Assistant AdministratorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Renee Campbell made an unannounced annual visit to this facility on 05/05/2023. LPA was met by the facility administrator Virginia Cristobal, Assistant Administrator.

Administrator and LPA toured the facility and all rooms not excluding bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms of which 4 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 degrees Fahrenheit. Hot water was measured at 105 degrees Fahrenheit Bathrooms are equipped with grab bars. 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 visit. Fire extinguisher was last serviced on 02/09/2023. Emergency Disaster Plan was last posted on 01/06/2023. First aid kit was observed to be complete. Fire drill was last conducted on 04/09/2023.

LPA reviewed staff record 2 out of 3 files and the facility has sufficient staffing to provide the services needed to meet the residents’ needs. All staff have criminal record clearance and are associated to the facility. The facility serves residents with dementia and staff have received the necessary training hours specific to dementia. LPA reviewed 2 of 2 residents’ files and a sample of residents’ medication logd were reviewed. MAR and medication on hand were verified.

No deficiencies were cited during this inspection.
Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISOR'S NAME: Emerita CurielTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023
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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