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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701274
Report Date: 07/27/2023
Date Signed: 07/27/2023 10:51:49 AM

Document Has Been Signed on 07/27/2023 10:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:GOOD DAYSFACILITY NUMBER:
032701274
ADMINISTRATOR:SIX, ZULLYFACILITY TYPE:
735
ADDRESS:13511 BATES RDTELEPHONE:
(209) 296-4699
CITY:SUTTER CREEKSTATE: CAZIP CODE:
95685
CAPACITY: 4CENSUS: 0DATE:
07/27/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Zully Six TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility announced to conduct a pre-licensing visit. LPA met with Licensee Zully Six and Paul Six.

LPA observed zero residents in careLPA and Licensee/Administrator toured the facility to ensure compliance of Title 22 regulation. LPA toured common areas, dining room, bathrooms (2), bedrooms (4), and exterior plant. LPAs observed the area where the staff and resident files will be locked and readily available for review. Emergency disaster plan and necessary signage posted and available. LPAs observed no obstruction of emergency exits inside or outside of facility.

Resident bedrooms observed to have necessary furniture. Resident bedrooms are furnished with a bed, chair, night stand, personal dresser, and extra closet space. All emergency exits have appropriate signage. Cleaning supplies were secured and locked in the storage space. LPA observed smoke detectors and carbon monoxide detectors were noted and functioning properly. LPA Valerio and Administrator observed the hot water temperature in bathroom to be within regulatory range. LPA observed area where food supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days will be maintained on the premises. LPA Valerio observed fire extinguisher in place outside of kitchen area and fully charged. The exterior plant has a gardening area, locked sheds, and a place for outdoor activities or visits. There is a fenced pool, however, it is not in use and no water was observed inside the pool.

Per California Code of Regulations (CCR) - no deficiencies were observed today. Pre-Licensing is complete and this facility has no deficiencies.Comp III was completed at the time of the visit. LPA Valerio to inform the CAB department that the visit has been completed. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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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