Community Care Licensing

Document Has Been Signed on 06/06/2023 03:37 PM - It Cannot Be Edited

FACILITY NAME:	RIVERA'S CARE HOME		FACILITY NUMBER:	397005280
ADMINISTRATOR:	RIVERA, ELIZABETH M.		FACILITY TYPE:	735
ADDRESS:	372 WEST DELHI STREET		TELEPHONE:	(209) 467-3761
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95206
CAPACITY: 4		CENSUS: 4	DATE:	06/06/2023
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Marilous Banes		TIME COMPLETED:	12:00 PM

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The following deficiencies, initially cited during a visit on 04/27/2023, have been cleared: Section Cited: 80088(e)(1) Date Due: 04/28/2023 Plan of Correction: Administrator lowered the thermostat during the tour and agreed to test the hot water for 3 days. Test hot water in the bathroom to meet Title 22 regulations. Send 3 day hot water temperature to LPA. Corrections: Cleared By Visit Clearance Date: 06/06/2023 Section Cited: 80087(a) Date Due: 05/12/2023 Plan of Correction: The Licensee will have these items repaired by the POC date of 5/12/23. The Licensee will submit the repair invoices to confirm completion of the needed repairs to the department by fax or email. Corrections: Cleared By Visit Clearance Date: 06/06/2023

SUPERVISORS NAME: Stephenie Doub LICENSING EVALUATOR NAME: Albert Johnson LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023