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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000568
Report Date: 09/23/2024
Date Signed: 09/23/2024 10:40:57 AM


Document Has Been Signed on 09/23/2024 10:40 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:SUMMERFIELD HOMEFACILITY NUMBER:
045000568
ADMINISTRATOR:NAPOCO, OENONEFACILITY TYPE:
735
ADDRESS:1010 GREENWICH DRIVETELEPHONE:
(530) 487-7266
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY:6CENSUS: 4DATE:
09/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator, Oenone NapocoTIME COMPLETED:
10:45 AM
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On September 23, 2024 at approximately 8:45 AM, Licensing Program Analyst (LPA), Farhaan Sarangi and Investigator, Drew Mitchell from the Community Care Licensing-Investigations Branch (IB) arrived unannounced at Summerfield Home for the purpose of conducting a Required 1 Year inspection. LPA and Investigator were greeted at the door by Administrator, Oenone Napoco, and was granted access into the facility. Clients were at their respective Day Programs.

LPA, Investigator, and Administrator toured the facility. LPA and Investigator observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on March 2024 at the time of the inspection. All smoke and Carbon Monoxide Detectors were tested and found to be operational during the inspection. Water temperature in facility bathroom measured at 115 degrees, within acceptable range of 105 to 120 degrees F. LPA and Investigator observed sufficient perishable and non-perishable foods located in the kitchen. There are special provisions made for individuals with special dietary needs. Food menu was presently available for viewing during the inspection. Medications were centrally stored and locked. Cleaning products and other toxins are located in the laundry room that was locked and inaccessible to clients in care. There was a supply of linens, cleaners, hygiene products and paper products available for clients. All bathrooms designated for clients in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms in clients rooms have a towel and soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of client bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms of COVID-19 or other infectious diseases are present in the facility. First Aid kit was inspected and found to be appropriate during the inspection. Emergency Disaster Drill was last conducted in July 2024.

(Report continued on LIC 809C)
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024
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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SUMMERFIELD HOME
FACILITY NUMBER: 045000568
VISIT DATE: 09/23/2024
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LPA reviewed 5 of 5 client files. Medication Administration Record (MAR) were reviewed for all clients in care and was found to be appropriate. During a file review, LPA and the Investigator observed that the clients cash resources were not available for review (See LIC 9102-Technical Advisory). LPA and Investigator educated the Administrator on the importance of ensuring that ALL client cash resources are available for review when doing annual inspections.

LPA requested the following documents to be sent:

LIC 500- Personnel Report
LIC 308- Designation of Facility Responsibility
LIC 309- Administrative Organization
Most up-to-date Liability insurance
Control of Property
Register of residents

No deficiencies were observed or cited during this Required 1 year inspection. Exit interview was conducted and a copy of this report was signed and given to the Administrator.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
LIC809 (FAS) - (06/04)
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