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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701537
Report Date: 09/08/2026
Date Signed: 09/08/2026 03:27:48 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/08/2026 03:27 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:BONNIE'S PLACEFACILITY NUMBER:
392701537
ADMINISTRATOR/
DIRECTOR:		WHITNEY, JENNIFERFACILITY TYPE:
740
ADDRESS:3117 BONNIE LANETELEPHONE:
(209) 483-9918
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 4CENSUS: DATE:
09/08/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Jennifer WhitneyTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On September 8, 2026 at 12:45PM, Licensing Program Analyst (LPA) Kimberly Kulich, arrived at Bonnie's Place at 3117 Bonnie Place, Stockton, for an unannounced annual visit. LPA Kulich observed the front yard was landscaped and maintained. LPA Kulich was greeted at the front door by Licensee/Administrator. LP Jennifer Whitney. There are currently no residents residing in the facility.

LPA Kulich observed the kitchen. All appliances are operable and in good working condition. There are enough clean plates and cutlery to meet capacity. Knives and sharp objects are stored in a container under the sink in a locked cabinet: keys are with staff; . Dishwasher soaps, cleaning supplies, paper towels and hazardous chemicals are stored and locked under the sink. No medication is kept in refrigerator or pantry. The kitchen stored seven (7) days of non-perishable. Due to residents not currently living in the facility, there are currently no perishable items in the facility.

Licensee observed the dining room. Administrator provided activity calendar and sample menu displayed on the wall. There is a table set in good repair with 6 chairs, enough seating to accommodate census & capacity).

LPA Kulich and licensee enter the backyard. LPA sees that the backyard is free of obstructions and hazardous materials and instruments. LPA notes a 4 seating accommodations.

LPA observed the bathroom 1. LPA measured water at 112*F which is compliant within the 105-120F degree range stated in regulation. LPA observed non-slip shower surface and handrail. Toilet, sink and shower are in good working order as demonstrated by licensee.

Lisa Rios
Kimberly Kulich
DATE: 09/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: BONNIE'S PLACE
FACILITY NUMBER: 392701537
VISIT DATE: 09/08/2026
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Licensee opened storage closet. LPA noted closet contains color coded towels and sheets, mattress covers, and additional supplies. Closet is organized and sheet assignments are easy to differentiate between residents. Each resident has their own towels and sheets. LPA Kulich observed multiple sets of additional spare linens, including bedding and towels.

LPA Kulich observed bedroom #1. Bedroom contains a lamp, chair, nightstand w/drawer, desk and bed. All furniture is in good repair. LPA observed room had closet with space for clothes and personal belongings.

LPA observes a single bathroom (#2) in the bedroom. Bathroom was observed to have non-slip surface and handrails.

LPA entered bedroom #2. Bedroom contains lamp, chair, nightstand w/drawer, desk and bed. All furniture is in good repair. LPA observed room had closet with space for clothes and personal belongings.

Medication will be stored in a locked closet located adjacent to the front door. MARS, medication, and first aid kit.

LPA reviewed 3 staff files. There are no residents. LPA interviewed 2 staff members.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Kimberly Camello.

NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Kimberly Kulich
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2026
LIC809 (FAS) - (06/04)
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