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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005071
Report Date: 01/12/2024
Date Signed: 01/31/2024 11:26:49 AM

Document Has Been Signed on 01/31/2024 11:26 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SONIA'S CARE HOME 2FACILITY NUMBER:
397005071
ADMINISTRATOR:GAPASIN, SONIAFACILITY TYPE:
740
ADDRESS:8240 RICHLAND WAYTELEPHONE:
(209) 609-9342
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 6CENSUS: 5DATE:
01/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Criselda PaltepTIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPA) Kesha Lewis arrived at the facility unannounced for the purpose of conducting a case management incident inspection regarding incident report received. LPA explained purpose of visit to staff and the administrator by phone.

The incident report was regarding a resident needing a higher level of care. this was not the first insistence this has happened. LPA reviewed incidents reports and resident files, the facility will email LPA Lewis requested documents by 02/02/2024. as the facility did not have a copier. facility will provide for R1-R2 care giver notes, VMRC admission agreement, any Incident reports, IPP, pre placement evaluation and any evaluations completed while in care.

Per California Code of Regulations, Title 22 no deficiencies were observed or cited during today's case management inspection. This matter is still under investigation.

An exit interview was conducted and a copy of this report was given.

Kesha.lewis@dss.ca.gov
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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