<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005072
Report Date: 08/10/2022
Date Signed: 08/10/2022 12:49:39 PM

Document Has Been Signed on 08/10/2022 12:49 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:SONIA'S GUEST HOME 3FACILITY NUMBER:
397005072
ADMINISTRATOR:GAPASIN, SONIAFACILITY TYPE:
740
ADDRESS:2933 ANGEL DRIVETELEPHONE:
(209) 609-9342
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 6CENSUS: 6DATE:
08/10/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Nora GaleTIME COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 8/10/22 at 12:45pm Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced inspection at Sonia's Guest Home 3 for the purpose of inspecting the facility's corrections to deficiencies cited on 8/4/22. LPA met with staff Nora Gale and together conducted Plan of correction (POC) inspection.

LPA tested the hot water and observed a recorded temperature of 107 degrees F. POC clearance letter was generated and left at the facility.

LPA also observed a new floor lamp in the living room/office and LPA tested the lamp to ensure it is operational. the new lamp is operational and provides adequate lighting to meet the regulations. POC clearance letter was generated and left at the facility.

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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 1