<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004985
Report Date: 02/17/2023
Date Signed: 03/02/2023 05:28:03 PM

Document Has Been Signed on 03/02/2023 05:28 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:CHOICE MANOR 2 ARFFACILITY NUMBER:
397004985
ADMINISTRATOR:LORETTA LIVINGSTON-ANTHONYFACILITY TYPE:
735
ADDRESS:7270 SOUTHFIELD WAYTELEPHONE:
(209) 472-9904
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 6CENSUS: 4DATE:
02/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Eva Mcdowell-BloomerTIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/17/23 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual visit. LPA Jensen. LPA Jensen met with house manager Eva McDowell-Bloomer and Licensee Loretta Livingston Anthony and explained the purpose of today's visit. Loretta Livingston-Anthony holds a current Administrator's certification # 6002812735 good through 4/23/23.

LPA Jensen toured the facility grounds. The grounds were observed to be maintained and all paths were observed to be clear of obstruction. The grounds have sufficient furniture and shade for outdoor activities. There are no bodies of water on the property. The interior of the facility was observed to be sanitary and free of odor. The facility was observed to have adequate lighting and furniture for the comfort of the residents. The thermostats were set between 68-71 degrees which falls within the required regulatory range of 68-85 degrees. The water temperature was also verified to be within the required regulatory range of 105-120 degrees. The facility maintains a first aid kit that was observed to be complete. The facility has a storage shed on the property with emergency supplies. The fire extinguisher was last serviced in March of 2022 and is in compliance. The carbon monoxide detector was determined to be in good working order. The facility maintains flashlights and lanterns in case of power outages

The facility has 4 bedrooms and 1 live in staff room. The bedrooms are all equipped with dressers, night stands, lamps, chair and beds. The bathrooms were observed to have grab bars at the toilet and shower. The shower was observed to have non-slip flooring. LPA Jensen observed an adequate supply of linens and toiletries.

The facility maintains in excess of a 2 day supply of perishable food and a 7 day supply of non-perishable food. All food that is not in the original packaging is labeled and the original packaging is retained for reference. No expired food was observed.
Continued on LIC 809C....




SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: CHOICE MANOR 2 ARF
FACILITY NUMBER: 397004985
VISIT DATE: 02/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued on LIC 809C....
All medication, toxins, chemicals and sharp objects were observed to be locked and inaccessible to residents in care. Resident rights were observed to be posted in a prominent location. COVID mitigation signage was observed throughout the facility.

LPA Jensen reviewed the medication for R1 and compared it against the Medication Administration Record and found the record keeping to be accurate. LPA Jensen reviewed the P&I fund records for R1 and in the presence of the Administrator verified the record keeping to be accurate.

LPA Jensen reviewed the staff files for the 2 staff members present at the facility and determined the files to be complete and in compliance.

LPA Jensen requested the following items be emailed to maja.jensen@dss.ca.gov by 2/24/23:

Current LIC 500
Current Liability Insurance
Current Surety Bond

The Infection Control Inspection tool was completed. The facility was observed to be in substantial compliance.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3