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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397202962
Report Date: 11/04/2024
Date Signed: 11/04/2024 12:07:34 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/04/2024 12:07 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:CABRERA'S GUEST HOME 2FACILITY NUMBER:
397202962
ADMINISTRATOR/
DIRECTOR:
ELISEO CABRERAFACILITY TYPE:
735
ADDRESS:1495 LAGUNA CIRCLETELEPHONE:
(209) 598-7588
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 6CENSUS: 4DATE:
11/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:DignaTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA spoke with Digna Cabrera and explained the purpose of the visit.

LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. 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 is within the required range of 105 to 120 degrees.

Fire extinguishers and smoke detectors are operational. Centrally stored medications are kept locked and inaccessible to residents. The first aid kit is complete. There is a carbon monoxide detectors in the facility. Fire drill was conducted.

No deficiencies were cited pursuant to Title 22 rules and regulations, Health and Safety Codes.

Exit interview conducted
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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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