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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300604201
Report Date: 10/24/2022
Date Signed: 10/24/2022 03:47:37 PM

Document Has Been Signed on 10/24/2022 03:47 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:STOCKER GROUP HOMEFACILITY NUMBER:
300604201
ADMINISTRATOR:STOCKER, JUANITAFACILITY TYPE:
735
ADDRESS:622 SOUTH TOWNSENDTELEPHONE:
(714) 356-0760
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY: 6CENSUS: 2DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Brenda Hall, AdministratorTIME COMPLETED:
04:00 PM
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On 10/24/2022 , Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct a required annual inspection. LPA rang the bell but found the facility to be initially empty. Administrator Brenda Hall arrived approximately 20 minutes later along with the two clients living at the facility. LPA was greeted and granted entry by Brenda Hall, Administrator after explaining the purpose of the visit.

LPA accompanied by administrator toured the physical plant. There are currently two (2) clients in care. The shared bedroom includes all necessary components. An ample supply of linen is observed. The shared bathroom is equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. Staff present is adequately cleared and associated in Guardian. The Administrator certificate is shown to be current and valid. The fire extinguisher present is mounted and charged. The maintenance tag attached is current.

Sharp instruments are stored away in a locked room. The centrally stored medication are located in a locked closet. Cleaning supplies are securely locked in the laundry room. LPA observed a sufficient supply of food and water present.

LPA and administrator toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture and a shaded area is present for the enjoyment of clients and visitors. The perimeter gates can easily be opened in an evacuation. There are no bodies of water on the premises.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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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