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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700261
Report Date: 07/22/2021
Date Signed: 07/22/2021 03:15:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ST. STEPHEN'S HOMEFACILITY NUMBER:
502700261
ADMINISTRATOR:ALMENDRALA, MARIAFACILITY TYPE:
740
ADDRESS:1309 OAKWOOD DRIVETELEPHONE:
(209) 488-4901
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:6CENSUS: 5DATE:
07/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Maria AlmendralaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Jason Lund conducted an unannounced annual inspection visit with Administrator Maria Almendrala. LPA Lund explained the reason for the visit to Administrator Maria Almendrala

LPA Lund and Administrator Maria Almendrala walked the facility the inside and outside of the facility. The facility was found to be clean, safe and sanitary, and in good repair. The facility temperature was comfortable. There are no bodies of water present at the facility. Toxins and sharp tools are stored inaccessible to residents. LPA observed sufficient supply of perishable and Non-perishable food supply and menu. Fire extinguishers, smoke detectors, and carbon monoxide detectors are in compliance.

No Deficiencies were observed at this time.

Exit interview conducted with Ms. Almendrala. Copy of Report Given
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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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