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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004497
Report Date: 01/03/2023
Date Signed: 01/04/2023 08:57:40 AM

Document Has Been Signed on 01/04/2023 08:57 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:NEW HOPE GUEST HOME-ALPINEFACILITY NUMBER:
397004497
ADMINISTRATOR:ROBERT FELIXFACILITY TYPE:
740
ADDRESS:3008 W. ALPINE AVENUETELEPHONE:
(209) 941-0519
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 6CENSUS: 5DATE:
01/03/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
05:15 PM
MET WITH:Mirage MulaTIME COMPLETED:
07:45 PM
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LPA Albert Johnson made an unannounced health and safety check. LPA met with Staff.

LPA was informed that the facility has been without power since 12/31/22. The facility was informed by PG&E that a tree had fallen on the power line and disrupted service to the area.

The facility has relocated to The La Qunita Inn located in Stockton. There are five residents in three rooms. There will be four staff working until 9 pm which ends their shift. The NOC shift will be covered by three staff, one in each room.

LPA checked the rooms for medications, food/snacks and resident files. The Staff were informed that they will be at the relocation address until 1/5/23.

The residents appear to be in good health at this time and there are no immediate safety concerns. The department will continue to monitor the situations with health and safety checks until the residents return to their residence.

Exit interview conducted with staff at the La Quinta Inn.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2023
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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