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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004764
Report Date: 08/17/2022
Date Signed: 08/17/2022 06:38:17 PM

Document Has Been Signed on 08/17/2022 06:38 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:EPJ'S CARE HOMEFACILITY NUMBER:
397004764
ADMINISTRATOR:MARYANN PATACSILFACILITY TYPE:
735
ADDRESS:6864 PERSHING AVENUETELEPHONE:
(209) 477-5247
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 6CENSUS: 6DATE:
08/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Febe GarvidaTIME COMPLETED:
01:45 PM
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On 8/17/22 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a case management visit. LPA Jensen met with care provider Febe Garvida and explained the purpose of today's visit.

LPA Jensen conducted an interview with a home health nurse and reviewed the file for resident 1 (R1),
Due to insufficient time LPA Jensen is unable to complete the case management during the course of today's visit and will return at a later date.

An exit interview was conducted with Febe Garvida and a copy of this report was emailed to Maryann Patacsil.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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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