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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700261
Report Date: 07/11/2024
Date Signed: 07/11/2024 08:03:46 PM


Document Has Been Signed on 07/11/2024 08:03 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: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:
07/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Maria AlmendralaTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an annual required inspection visit. LPA Lund met with staff and later with Administrator Maria Almendrala and explained the reason for the visit. Census: 5

LPA Lund and Administrator Maria Almendrala toured/inspected the inside and outside of the facility. LPA Lund observed required posters. The facility was found to be clean, safe and sanitary, and in good repair. The facility temperature was comfortable. The hot water temperature measure at 109 degrees F. There are no bodies of water present at the facility. Toxins and sharp tools are stored inaccessible to residents. LPA observed 2- day perishable and 7 – day non-perishable food supply and menu. Fire extinguishers (July 2024), smoke detectors, and carbon monoxide detectors are in compliance. First Aid kit is complete. Disaster drill conducted within the last six months. LPA reviewed 3 resident files and 2 staff files (reviewed staff has criminal record clearance). LPA Lund observed centrally stored medications are locked.

No deficiencies were observed. Exit interview conducted and report left.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024
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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