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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700264
Report Date: 02/21/2025
Date Signed: 02/21/2025 09:51:40 PM

Document Has Been Signed on 02/21/2025 09:51 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:JEWELL HOME CAREFACILITY NUMBER:
392700264
ADMINISTRATOR/
DIRECTOR:		RALH, MONICAFACILITY TYPE:
740
ADDRESS:1141 S. VAN BUREN STREETTELEPHONE:
(209) 323-4972
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 6CENSUS: 5DATE:
02/21/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Licensee Monica Plowden TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Unannounced case management visit conducted by Licensing Program Analyst (LPA) Jason who was met by the facility Licensee Monica Plowden. A brief interview was conducted with the facility designated Administrator at this time. Census 5

The purpose of this case management visit was to follow up, with quarterly visits, and inquire about the requirements that were laid out from the office meeting for the informal conference which took place on 12/03/2024.

Since the meeting the Licensee Monica Plowden had training. On 12/20/2024 facility staff & Licensee Monica Plowden had training from ARC on RCFE reporting requirements and medication management. On 3/6/2025 Licensee Monica Plowden has a meeting with TSP summary review.

The following issues were discussed and reviewed at this time:

· Fire Clearance
· Reporting Requirements
· Personal Rights
· Staffing
· Medication Policies and Procedures

There were no deficiencies observed or cited during today's case management visit.



Exit Interview
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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