Senior Care Records.

Facility Evaluation Report

Phoenix House ARF, INC, Stockton08/13/2025Licence 392700981

Capacity5
Census5
Date signed08/13/2025 11:45:18 AM
Name of licensing program analystNoel Wolf Petersen
Name of licensing program managerLiza King
The inspector’s account

On 8/13/2025 at 10:00 AM, Licensing Program Analyst(LPA) Noel Wolf Petersen, arrived to conduct a case management regarding consumption of a foreign object. LPA met with administrator Rae Bolden, and explained the purpose of the visit. Phoenix house is licensed as an Adult Residential Facility with a maximum capacity of 5 aged 18-59 ambulatory clients, 1 of 5 have restricted conditions. exceptions exist for the relevant clients. The foreign object consumption, was a repeated behavior for R1 but not at Phoenix house. R1 was taken to the hospital for xray, r1 passed the object normally. LPA asked to review the the residents preappraisal and most recent 602 and mental health evaluation. The specific behavior is not documented as a concern from either physician, getting new documentation regarding the specific behavior is being discussed with VMRC.

LPA asked about the new monitoring measures implemented for r1, both as a immediate and longer term measures: If R1 needs the channel changed on r1's TV or to interact with a small objects, the protocol for now is to come and ask so that r1 can be observed and redirected if necessary from consuming any foreign objects. The choking hazzardable personal property has been removed from r1's room(wires, art supplies, legos, small toys, knicknacks), LPA observed R1 still has full access to those things with supervision, the remote to r1's TV has been moved over to the kitchen in full view of the floor staff, the removed effects are in a box the garage. In the long term, a tablet with an app for interfacing with the TV will let R1 have full autonomy of r1's TV, although choking hazzardable property will still be accessed only with direct supervision.

LPA interviewed r1 and the 2 staff with regards to the implementation of the new measures. LPA requested to be emailed the needs and services plan once it is updated to include addressing the new measures. An exit interview was conducted. No citations were issued as part of this visit. a copy of the report was read and given to the administrator.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction