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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005571
Report Date: 02/24/2023
Date Signed: 02/24/2023 01:50:30 PM

Document Has Been Signed on 02/24/2023 01:50 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:ENCLAVE AT THE DELTAFACILITY NUMBER:
397005571
ADMINISTRATOR:LO, SUSANFACILITY TYPE:
735
ADDRESS:4951 EIGHT MILE ROADTELEPHONE:
(209) 210-4863
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 45CENSUS: 44DATE:
02/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Susan LoTIME COMPLETED:
01:55 PM
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On 2-24-23 at 12:00pm, Licensing Program Analyst (LPA) conducted a case management visit regarding 2 incidents which occurred on 1-28-23. LPA met with Administrator Susan Lo and explained the purpose of the visit. LPA interviewed Administrator and reviewed incident reports dated 1-30-23, and physician’s reports for resident1 (R1) and R2. LPA also reviewed resident sign in and sign out sheets dated 1-28-23, and facility’s missing person policy. Based on interview and record review, it was determined that on 1-28-23 R1 signed out of facility at 4:23pm; R2 signed out of facility at 2:15pm on 1-28-23.

Based on incident report and interview, R1 and R2 did not return by curfew times of 8:00pm on 1-28-23. Staff search local area but were unsuccessful in locating R1. Facility notified appropriate parties including licensing department, responsible persons and local law enforcement per regulatory time frames and internal company policy. Facility staff learned on 1-30-23 that R1 had been in policy custody since 1-28-23. R2 was not located per local law enforcement notification updated on 2-23-23, and bed hold was initiated by R2’s conservator. R1 and R2 no longer reside at facility.

LPA review of sign in and out forms dated 1-28-23 revealed R1 and R2 signed out and included intended destination alerting staff of R1 and R2’s general whereabouts.


Based on today’s case management no citations are issued. An exit interview was conducted with Susan Lo and a copy of this report was left with Susan.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
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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