Community Care Licensing

Document Has Been Signed on 08/30/2023 11:12 AM - It Cannot Be Edited

FACILITY NAME:	RIVERA'S CARE HOME II		FACILITY NUMBER:	397004396
ADMINISTRATOR:	RIVERA, ELIZABETH M.		FACILITY TYPE:	735
ADDRESS:	3809 LADY JANE LANE		TELEPHONE:	(209) 983-9108
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95206
CAPACITY: 6		CENSUS: 6	DATE:	08/30/2023
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	09:59 AM
MET WITH:	Carmelita Queros		TIME COMPLETED:	11:15 AM

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The following deficiencies, initially cited during a visit on 08/07/2023, have been cleared: Section Cited: 80088(e)(1) Date Due: 08/08/2023 Plan of Correction: Staff lowered the thermostat during the tour. The facility will test the hot water for 3 days. Test hot water in the bathroom to meet Title 22 regulations. Send 3 day hot water temperature to LPA by 8/12/2023 Corrections: Cleared By Visit Clearance Date: 08/30/2023

SUPERVISORS NAME: Stephenie Doub LICENSING EVALUATOR NAME: Albert Johnson LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023