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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005571
Report Date: 06/14/2022
Date Signed: 06/14/2022 11:53:25 AM

Document Has Been Signed on 06/14/2022 11:53 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ENCLAVE AT THE DELTAFACILITY NUMBER:
397005571
ADMINISTRATOR:LEAH B ZUBIATEFACILITY TYPE:
735
ADDRESS:4951 EIGHT MILE ROADTELEPHONE:
(209) 210-4863
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 45CENSUS: 42DATE:
06/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Susan Lo, Facility Supervisor TIME COMPLETED:
12:10 PM
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On 06/14/2022 at 10:50 AM, Licensing Program Analyst (LPA) T. White arrived unannounced to conduct a case management visit regarding the incident reports submitted to CCLD. LPA met with Facility Supervisor, Susan Lo and explained the purpose of the visit.

Based on documentation, CCLD has received multiple incidents regarding clients absence without leave (AWOLs). Based on Staff #1 (S1) interview, there was a total of 14 AWOLs from January 2022 to June 2022. Based on interview, 11 clients have AWOL'd from January 2022 to June 2022. Based on Physician Reports, 11 of 11 clients are able to leave unassisted. However, it was determined that clients leave the facility without following sign in and sign out procedures which is documented on the plan of operation. Staff on duty were unaware of the clients location during the course of the absences. LPA advised to follow the technical assistance guidance.

No deficiencies were cited as a result of today's visit.

Exit interview conducted with Facility Supervisor and a copy of report given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Treana White
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2022
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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