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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005472
Report Date: 04/03/2024
Date Signed: 04/03/2024 03:43:03 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/03/2024 03:43 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:A DAY AWAYFACILITY NUMBER:
397005472
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		LEAL-MALLETE, PENNYFACILITY TYPE:
775
ADDRESS:3550 WAGNER HEIGHTS RDTELEPHONE:
(209) 956-3400
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 15CENSUS: 2DATE:
04/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:TIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Kesha Lewis conducted an unannounced to conduct the 1 year required visit. LPA met with Jessica Ruiz and explained the purpose of the visit.

LPA inspected physical plant including but not limited to (1) Large recreation room and two (2) bathrooms and a patio area. LPA observed sufficient furniture and lighting throughout the program. The smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present. in the kitchen area under the sink LPA observed toxins to be associable to residents in care in a draw in the kitchen area a large knife was found (Photos taken).

First aid kit was checked and is complete. 2 Resident’s records were reviewed the program is currently open and has been running sine June 2023.

LPA Observed clients or staff at this time playing a game and food was waiting for snack.

Per California Code of Regulations, Title 22 Division 6, Chapter 8 and Health and Safety Code, Deficiencies were cited during this visit. See 809D page.

Exit interview held and a report given at the conclusion of the inspection.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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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Document Has Been Signed on 04/03/2024 03:43 PM - It Cannot Be Edited


Created By: Kesha Lewis On 04/03/2024 at 02:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: A DAY AWAY
FACILITY NUMBER: 397005472

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/03/2024
Section Cited
CCR
82087(a)(3)

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82087 Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
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Adminstraor locked away toxins and knife when showed by LPA Lewis. No Futher POC is needed.
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Based on observation the licensee did not comply with the section cited above. Licensee did not ensure that cleaning solutions, toxins and shaprps are made inaccessible to residents in care which poses/posed an imitate health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Liza King
LICENSING EVALUATOR NAME:Kesha Lewis
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024


LIC809 (FAS) - (06/04)
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