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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700261
Report Date: 07/20/2022
Date Signed: 07/20/2022 02:38:31 PM


Document Has Been Signed on 07/20/2022 02:38 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
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: 6DATE:
07/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator Maria AlmendralaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above address unannounced to conduct an annual/required inspection visit. LPA Lund explained the reason for the visit to Administrator Maria Almendrala

LPA Lund and Administrator Maria Almendrala toured the facility inside, including but not limited to kitchen, bedrooms, bathrooms, living and dining room area. 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 Administrator Maria 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: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
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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