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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005730
Report Date: 08/02/2024
Date Signed: 08/02/2024 01:08:22 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/02/2024 01:08 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:EPJ'S CARE HOMES #2FACILITY NUMBER:
397005730
ADMINISTRATOR/
DIRECTOR:
MARYANN PATACSILFACILITY TYPE:
735
ADDRESS:311 MISSION PARK DRTELEPHONE:
(209) 477-4799
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 6CENSUS: 6DATE:
08/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH: Marylin PatacsilTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 08/02/2024 at 11:30 AM, Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Marylin Patacsil and Ernesto Patacsil and explained the purpose of the visit.

LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate. The facility is licensed for six ambulatory clients, which four may be non-ambulatory. There are currently 6 residents who reside at this facility.

The LPA Martinez toured the facility with Maryann Patacsil on 08/01/2024 at 11:30 PM.

LPA Martinez reviewed six resident files and four staff files, which all files were maintained. The facility has an infection control plan and a natural disaster plan. The facility common areas, bedrooms, bathrooms, laundry room, and kitchen are sanitary and furnished. The facility has an adequate food supply. The exterior of the facility is sanitary and clear of debris. The facility has an area for activities. The last fire drill was July 21, 2024. LPA Martinez reviewed two medication administration records (MAR). Facility temperature measured at 72 degrees. The fire extinguisher, carbon detector, and smoke detectors are in good repair.

Based on this annual inspection, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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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