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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005719
Report Date: 09/10/2024
Date Signed: 09/10/2024 03:42:51 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/10/2024 03:42 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/
DIRECTOR:
CABRERA, DIGNAFACILITY TYPE:
735
ADDRESS:2955 CHRISTINA AVETELEPHONE:
(209) 598-7588
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 6CENSUS: 6DATE:
09/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:11 PM
MET WITH:D. CabreaTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
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On 9/10/2024, Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection.

The physical plant including the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards are in compliance. There is sufficient furniture and lighting throughout the facility. There is sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 112.0 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees.

Fire extinguishers and smoke detectors are current and in compliance with fire safety. The centrally stored medications are locked. Fire drill was completed on 8/2024.

All staff are fingerprint cleared and associated to the facility. First aid kit was checked and is complete.

No deficiencies were cited.

Exit interview conducted
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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