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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701000
Report Date: 07/26/2022
Date Signed: 07/26/2022 11:30:23 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/26/2022 11:30 AM - 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:VILLA THERESA 2 CARE HOMEFACILITY NUMBER:
392701000
ADMINISTRATOR:ALAN, JOSE FFACILITY TYPE:
740
ADDRESS:3028 MCCOOK WAYTELEPHONE:
(209) 462-4239
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 6CENSUS: DATE:
07/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:09 AM
MET WITH:Alan JoseTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Markhel Silette and explained the purpose of the visit.

LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards.

LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at required range of 105 to 120 degrees.

Fire extinguishers and smoke detectors are current and in compliance with fire safety. All staff are Fingerprint cleared and associated to the facility.

No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2022
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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