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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701016
Report Date: 08/28/2024
Date Signed: 08/28/2024 10:53:53 AM

Document Has Been Signed on 08/28/2024 10:53 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:POPPY LANE CARE HOMEFACILITY NUMBER:
032701016
ADMINISTRATOR/
DIRECTOR:
COCJIN, AARONFACILITY TYPE:
735
ADDRESS:100 POPPY LANETELEPHONE:
(559) 360-9058
CITY:IONESTATE: CAZIP CODE:
95640
CAPACITY: 4CENSUS: 0DATE:
08/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Nathan Yesowitch, staffTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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 8/28/24, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual inspection of the facility. Arriving to find no vehicles in the driveway, LPA knocked on the front door but received no response. LPA notified Administrator Aaron Cocjin of the visit via phone call and informed LPA that a staff will be assigned to accommodate LPA with the visit., as the Administrator was unavailable. The Administrator authorized the staff to assist with the inspection and sign the report on their behalf. Staff arrived shortly after.

Administrator Cocjin confirmed that the licensees wish to keep the license active while maintaining their vendorization with Valley Mountain Regional Center (VMRC). The facility, which is licensed to accommodate four adult residents, currently has no residents. The facility is presently occupied by the licensee's staff.

LPA conducted a comprehensive inspection of the facility’s physical plant to verify compliance with Title 22 regulations. The single-story home, situated in a residential neighborhood. The indoor temperature was well-regulated at73°F. The hallway bathroom, along with two resident bedrooms (identified as bedrooms #1 and #2 on the facility sketch), were inspected and found to be well-maintained and in good repair. The kitchen was also observed to be clean and in good repair. With no residents currently present, food supplies were not inspected.

Safety measures were thoroughly checked: a fire extinguisher, last serviced in December 2023, was located in the kitchen; the fireplace was properly screened; and no emergency exits were blocked. The smoke detector/carbon monoxide monitor combination was operational upon testing.

During an inspection of the external part of the facility, LPA noted that the left-side fence was slightly leaning and observed security cameras around the facility’s perimeter. The facility features a covered outdoor area with furniture for resident activities, and no bodies of water were observed at this time. The front yard was observed to be well-maintained. window screens were also observed to be in good repair.

Given the absence of residents and staff, resident and personnel records were not reviewed during this visit.

In accordance with California Code of Regulation (CCR) - Title 22, no deficiencies were found. An exit interview was conducted with staff, and a copy of the inspection report was provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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 1