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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701274
Report Date: 02/06/2024
Date Signed: 02/06/2024 04:18:38 PM

Document Has Been Signed on 02/06/2024 04:18 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:GOOD DAYSFACILITY NUMBER:
032701274
ADMINISTRATOR:SIX, ZULLYFACILITY TYPE:
735
ADDRESS:13511 BATES RDTELEPHONE:
(209) 296-4699
CITY:SUTTER CREEKSTATE: CAZIP CODE:
95685
CAPACITY: 4CENSUS: 1DATE:
02/06/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Paul SixTIME COMPLETED:
04:15 PM
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On 2/6/24, at 3pm, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced a post licensing visit, with the use of the CARE Inspection Tool. LPA met with Paul Six, co-licensee, and explained the purpose of today’s visit. Present during this visit, there were 1 client in care with 1 staff on duty.

At 3:15pm, LPA inspected the facility’s physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. The facility is a one-story structure located in a residential neighborhood. Pool is empty and inaccessible. Outside of the facility was observe to be cleaned and clear of obstructions. Additionally, LPA observed outdoor furniture for residents’ use and area for outdoor activities. Entrance, exits and hallways were observed to be clear of obstructions. LPA observed 4 client bedrooms and 2 bathrooms for client use. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the resident's personal belongings. Bed linens, comforters, and bath towels were adequately stocked during the visit. Bathrooms were operational and adequately supplied including with grab bars and non-skid flooring.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were locked and not accessible to residents in care. The kitchen was inspected, and sufficient 2-day perishable and 7-day non-perishable food was maintained adequately. Room temperature was maintained in the facility at 69 degrees F. Water temperature in one of the bathroom was measured at 106 degrees F. Fire extinguisher was serviced on 6/24/23. Smoke detectors and carbon monoxide were tested and found to be operable during this visit.

{Con't to LIC809-C}

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2024
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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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: GOOD DAYS
FACILITY NUMBER: 032701274
VISIT DATE: 02/06/2024
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{Con't from LIC809}

Medication storage area was observed to be locked and inaccessible to clients in care. First aid kit was observed to have adequate supplies and accessible to staff. The facility maintains for client Centrally Stored Medication, Destruction Record and PRN Log. LPA observed the facility's infection control practices. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for client use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of client in care.

During this inspection, LPA conducted an audit of facility files, 1 client files, and 2 staff files for regulatory compliance. LPA completed 1 client interview and 1 staff interview. Client files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Staff files reviewed contained all required contents including health screening, TB results, current first aid/CPR, and initial training. The facility is current on annual license fees. LPA requested an updated copy of LIC 308 and LIC 500.

Per California Code of Regulations (Title 22, Division 6, Chapter 8), no deficiencies were observed during this visit. An exit interview was held with Paul Six, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
LIC809 (FAS) - (06/04)
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