Community Care Licensing

Document Has Been Signed on 10/14/2024 02:13 PM - It Cannot Be Edited

FACILITY NAME:	A1 DEL MONTE STOCKTON		FACILITY NUMBER:	392700993
ADMINISTRATOR/ DIRECTOR:	SANDEEP SAINI		FACILITY TYPE:	740
ADDRESS:	517 E. FULTON STREET		TELEPHONE:	(209) 910-5910
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY: 158		CENSUS: 156	DATE:	10/14/2024
TYPE OF VISIT:	POC	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	S Sandeep		TIME VISIT/ INSPECTION COMPLETED:	11:54 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	The following deficiencies, initially cited during a visit on 05/01/2024, have been cleared: Section Cited: 87307(a)(2)(c) Date Due: 05/15/2024 Plan of Correction: The facility has addressed the room access point and has established an alternative enrty into the shower /bathroom area. Corrections: Cleared By Visit Clearance Date: 10/14/2024 No citation issued.

SUPERVISORS NAME: Lisa Rios LICENSING EVALUATOR NAME: Albert Johnson LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2024