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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004764
Report Date: 08/04/2023
Date Signed: 08/04/2023 12:30:42 PM

Document Has Been Signed on 08/04/2023 12:30 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: 5DATE:
08/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Febe GarvidaTIME COMPLETED:
12:45 PM
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On 8/4/23 at approximately 10:00am Licensing Program Analyst (LPA) arrived at facility unannounced to conduct a required 1 year visit. LPA Jensen met with care provider Febe Garvida as the Administrator was not available. LPA Jensen spoke to Marilyn Patacsil by telephone who advised that the LPA should work with the care provider as neither of the administrator's are available. The Administrator holds current Administrator's Certificate good through 11/29/2024. The facility is licensed for 6 ambulatory clients.

LPA Jensen toured the grounds and observed them to be well maintained and all paths were free of obstruction. There is outdoor furniture available for client use and shaded areas. There are no bodies of water on the property.

LPA Jensen toured the physical plant and observed the facility to be sanitary and free of odor. There was adequate lighting and furnishings observed throughout. The facility maintains an adequate supply of linen. There are night lights available in the hallway. There are 3 client bedrooms and all are double occupancy. The bedrooms are equipped with night stands, dressers, lamps and chairs. The thermostat was set at 71 degrees Fahrenheit which falls within the required range of 68-85 degrees. The temperature of the water in a client ensuite bathroom was measured at 112 degrees Fahrenheit which falls within the required range of 105-120 degrees Fahrenheit.

LPA Jensen toured the kitchen and confirmed the facility is maintaining at least a 2 day supply of perishable food and a 7 day supply of non-perishable food. There was no expired food product observed. LPA Jensen observed fresh fruit and produce available for client consumption. The knives were observed to be locked and inaccessible to residents in care. The medication is stored in the kitchen and is locked and inaccessible to residents in care. LPA Jensen conducted a random audit of medication and found the record keeping to be accurate. P&I funds are also stored in the kitchen and locked. LPA Jensen conducted a random audit of P&I funds and found the accounting to be accurate.
Continued on LIC 809C...
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME
FACILITY NUMBER: 397004764
VISIT DATE: 08/04/2023
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At the time of this visit 2 clients were at the facility and 3 were at day program. LPA Jensen interviewed 1 of 2 clients as the second client was unable to communicate effectively. During the course of the visit both clients appeared to have their needs met. LPA Jensen interviewed 1 of 2 staff members.

LPA Jensen reviewed 5 of 5 client files and determined that 4 of 5 client files had outdated Individual Program Plans (IPPs). Technical assistance was provided. LPA Jensen determined that Resident 1 was admitted on 8/1/23 and lacked a current Needs and Service Plan. LPA Jensen spoke to Marilyn Patacsil by telephone who stated that the Needs and Service Plan for the client will be provided to LPA by Monday 8/7/23 as this was an emergency placement.

LPA Jensen reviewed 2 of 3 staff files. The staff files were determined to be complete and in compliance. Staff present at the facility were determined to be fingerprint cleared and associated to the facility.

The fire extinguisher and smoke detector were tested and found to be in good working order. The fire extinguisher was last serviced in March of 2023 and is in compliance. The facility conducts monthly fire drills. The facility maintains multiple first aid kits and all necessary components of the first aid kits were present.

The facility was determined to be in substantial compliance and no deficiencies were issued.

An exit interview was conducted with Febe Garvida and a copy of this report and appeal rights were given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC809 (FAS) - (06/04)
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