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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004497
Report Date: 07/16/2024
Date Signed: 07/26/2024 09:31:41 AM


Document Has Been Signed on 07/26/2024 09:31 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:NEW HOPE GUEST HOME-ALPINEFACILITY NUMBER:
397004497
ADMINISTRATOR:ROBERT FELIXFACILITY TYPE:
740
ADDRESS:3008 W. ALPINE AVENUETELEPHONE:
(209) 941-0519
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:6CENSUS: 6DATE:
07/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:R. FelixTIME COMPLETED:
11:31 AM
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On 7/16/2024, Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual inspection on this date. LPA met with R. Felix and explained the purpose of the visit.

LPA inspected physical plant including but not limited to kitchen, bedrooms, bathrooms, living and dining room area. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in or around the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 110 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present. LPA observed centrally stored medications locked inside the medication room. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 4 resident and 3 staff files, including criminal record clearances. All staff today are Fingerprint cleared and associated to the facility. First aid kit was checked and is complete. Fire drill was completed on 6/2024

Per California Code of Regulations, Title 22 Division 6, Chapter 8 and Health and Safety Code, No deficiencies were cited during this visit. Exit interview held and a report given at the conclusion of the visit
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2024
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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