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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004497
Report Date: 05/09/2023
Date Signed: 05/09/2023 03:37:54 PM

Document Has Been Signed on 05/09/2023 03:37 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, 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:
05/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Robert FelixTIME COMPLETED:
03:50 PM
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On 5-9-23 at 2:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding resident rights and care and supervision related to an incident report received on 3-27-23. LPA met with Administrator Robert Felix and explained the purpose of the visit. LPA conducted facility tour and interviewed/observed 3 of 5 residents in care. LPA also reviewed individualized program plan (IPP) and care notes for 3 of 5 residents in care. Additionally, LPA interviewed Administrator.

LPA observed facility to be clean and sanitary with no foul odors. Resident in care were observed to be appropriately clothed and groomed. LPA also observed resident rooms to be clean and sanitary with all appropriate furniture and furnishings in place. Bathrooms were clean and contained all necessary items to use for showering and bathing assistance. Grooming items were observed to be in place for each resident in care.

LPA observed 3 staff on duty plus Administrator providing necessary and adequate care to residents including feeding and activities of daily living (ADL) assistance. Facility current census is 5.

As a result of today's case management, no citations are issued. An exit interview was conducted with Robert Felix and a copy of this report was left with Robert.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
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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