Community Care Licensing

Document Has Been Signed on 08/26/2021 11:33 AM - It Cannot Be Edited

FACILITY NAME:	ALCOR GUEST HOME		FACILITY NUMBER:	397202967
ADMINISTRATOR:	POIER, CORAZON		FACILITY TYPE:	735
ADDRESS:	2193 ALTA SIERRA STREET		TELEPHONE:	(209) 981-9814
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95206
CAPACITY: 5		CENSUS: 5	DATE:	08/26/2021
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	11:04 AM
MET WITH:	Cora Poier		TIME COMPLETED:	11:50 AM

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LPA Johnson arrived unannounced to clear the POC's from visit dated 08/12/2021. The following deficiencies, initially cited during a visit on 08/12/2021, have been cleared: Section Cited: 80092.2(a) Date Due: 08/23/2021 Plan of Correction: Administrator shall submit an updated health care plan for R1 and R2. This shall be done by POC date 8/23/2021. Fax the information to CCL. Corrections: Cleared By Visit Clearance Date: 08/26/2021

SUPERVISORS NAME: Stephenie Doub LICENSING EVALUATOR NAME: Albert Johnson LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021