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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004497
Report Date: 12/19/2024
Date Signed: 12/19/2024 02:45:44 PM

Document Has Been Signed on 12/19/2024 02:45 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:NEW HOPE GUEST HOME-ALPINEFACILITY NUMBER:
397004497
ADMINISTRATOR/
DIRECTOR:		ROBERT FELIXFACILITY TYPE:
740
ADDRESS:3008 W. ALPINE AVENUETELEPHONE:
(209) 941-0519
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 6CENSUS: DATE:
12/19/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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An Non-compliance Conference was held in the Sacramento South Regional Office on today's date. Via teams. The purpose of the Conference was to discussed the recent complaint investigation.

Present at the meeting:

1. Lisa Rios, Licensing Program Manager
2. Stephenie.Doub, Regional Manager
3. Robert Felix, Administrator
4. Erick Hernandez, VMRC
5. Katina Richison,VMRC
6. Brian Bennett, VMRC

The purpose of this meeting is to discuss the allegations:

Licensee does not have funds to pay facility bills.
Licensee allowed residents to live in a facility without power.
Licensee did not report power outage.

Continued
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Lisa Rios
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: NEW HOPE GUEST HOME-ALPINE
FACILITY NUMBER: 397004497
VISIT DATE: 12/19/2024
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Licensee/Administrator has agreed to submit the following by 12/19/2024:
  • Facilities bank records for two months due to CCL.
  • Emergency disaster plan update to include power outage will be sent to both CCL and VMRC by 1/2/24.

The Regional Office will do the following:
  • Continue to be available for Licensee for any guidance
  • Continue to monitor facility for compliance and ensure the health and safety of the residents in care.
  • Request an audit

Per California Code of Regulations (CCR), deficiencies are not being cited. An exit interview was held, and a copy of the report was provided via email. Licensee to review, sign, and send a copy back to LPA and LPM.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Lisa Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC809 (FAS) - (06/04)
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