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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297001009
Report Date: 03/27/2024
Date Signed: 03/28/2024 10:07:30 AM

Document Has Been Signed on 03/28/2024 10:07 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:CLAUDIA S. COOK HOMEFACILITY NUMBER:
297001009
ADMINISTRATOR:CLAUDIA S. COOKFACILITY TYPE:
735
ADDRESS:10140 WILD TURKEY LANETELEPHONE:
(530) 432-6983
CITY:SMARTSVILLESTATE: CAZIP CODE:
95977
CAPACITY: 6CENSUS: 4DATE:
03/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Claudia and Jeff CookTIME COMPLETED:
05:00 PM
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On 3/27/2024 LPA Tryon visited the facility to do an annual visit. LPA met with Claudia and Jeff Cook. LPA toured the facility including common areas, kitchen, bedrooms, bathrooms, laundry, dining area, outside area. The facility has smoke and carbon monoxide detectors installed, fire extinguishers are present and charged.
The facility is clean, nicely furnished and in good condition.
Food supplies are appropriate to meet requirements of 2 days perishable and 7 days non-perishable supplies.
Bedrooms are appropriately furnished. Bathrooms are clean and functional.
No hazards were noted.
LPA reviewed the CARE Tool with licensees.
The facility appears to be in substantial compliance with regulations.
No deficiencies were noted at this visit.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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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