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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005571
Report Date: 11/17/2022
Date Signed: 11/17/2022 11:22:01 AM

Document Has Been Signed on 11/17/2022 11:22 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: 43DATE:
11/17/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Susan Lo - Residential Service CoordinatorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 - Year Annual inspection. LPA met with residential service coordinator . LPA explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 45 ambulatory clients.

LPA and residential service coordinator toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 73 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in clients shared bathroom measured at 114.4 F which meets requirement of 105 and 120 degrees F. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. There is a minimum of 7 day nonperishable and 2 day perishables foods.

LPA observed smoke detectors are interconnected with the fire department and carbon monoxide in operating condition. Fire extinguisher was last serviced on 02/15/2022. LPA observed mitigation plan completed. First aid kit observed to be complete. Fire drill was last conducted on . During inspection,

LPA reviewed 5 resident files and 5 staff member files. All staff are fingerprint cleared and have current first aid certificates. All residents have required documents for community care licensing (CCL).

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited.

Exit interview conducted with residential service coordinator and a copy of report provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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