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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005719
Report Date: 03/21/2024
Date Signed: 03/21/2024 08:57:21 PM

Document Has Been Signed on 03/21/2024 08:57 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:DIGNA'S CARE HOME #1FACILITY NUMBER:
397005719
ADMINISTRATOR:CABRERA, DIGNAFACILITY TYPE:
735
ADDRESS:2955 CHRISTINA AVETELEPHONE:
(209) 598-7588
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 6CENSUS: 6DATE:
03/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:D CabreraTIME COMPLETED:
03:10 PM
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On 3/21/24, Licensing Program Analyst (LPA) Albert Johnson made an unannounced case management visit - incident on 3/19/2024. Regional office received a reports regarding R1. LPA spoke with Digna Cabrera, Administrator.

LPA reviewed R1's incident report, R1 was sent to ER to be checked for illness and knee pain. LPA confirmed that R1 was given medication(Tylenol) and sent home.

R1 is back to baseline without any need for further evaluation and has returned to day program.

Digna Cabrera contacted the family as well as Valley Mountain Regional Center.


No deficiencies were cited during today's visit.


Exit interview conducted
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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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