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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004764
Report Date: 08/22/2024
Date Signed: 08/22/2024 11:21:20 AM

Document Has Been Signed on 08/22/2024 11:21 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:EPJ'S CARE HOMEFACILITY NUMBER:
397004764
ADMINISTRATOR/
DIRECTOR:
MARYANN PATACSILFACILITY TYPE:
735
ADDRESS:6864 PERSHING AVENUETELEPHONE:
(209) 477-5247
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 6CENSUS: 6DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Febe Garvidi TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 08/022/2024 at 10:00 AM, Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Febe Garvidi and explained the purpose of the visit.

LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate. The facility is licensed for six ambulatory clients. There are currently 6 clients who reside at this facility.

The LPA Martinez toured the facility with Febe Garvidi on 08/22/2024 at 10:45 AM.

LPA Martinez reviewed three client files and three staff files, which were maintained. LPA Martinez reviewed two medication administration records (MAR), which were maintained. LPA Martinez reviewed the natural disaster plan and infection control plan. The last fire drill was on August 04, 2024. The smoke detectors and carbon detectors were in good repair. The exterior emergency gate was in good repair. The facility water temperature measured 120 degrees, and the facility temperature measured at 73 degrees. The facility common areas, bedrooms, and bathrooms were sanitary and clean. The exterior of the facility is clear of debris, and the shaded patio is furnished. The facility toxins are stored in a locked cabinet, and the laundry room is furnished and sanitary. The medication is stored in a locked cabinet.

Based on this annual inspection there were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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