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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297001009
Report Date: 04/04/2024
Date Signed: 04/04/2024 02:31:11 PM

Document Has Been Signed on 04/04/2024 02:31 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CLAUDIA S. COOK HOMEFACILITY NUMBER:
297001009
ADMINISTRATOR/
DIRECTOR:		CLAUDIA S. COOKFACILITY TYPE:
735
ADDRESS:10140 WILD TURKEY LANETELEPHONE:
(530) 432-6983
CITY:SMARTSVILLESTATE: CAZIP CODE:
95977
CAPACITY: 6CENSUS: 4DATE:
04/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Jeff Cook and Claudia CookTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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LPA Hiratsuka conducted this unannounced case management in response to Community Care Licensing Division (CCLD) doing a file review update. There were a couple of questions about the staff schedule.

The owner of this facility has live-in staff. The staff also own a day program called All-Star Programs 297003934. The staff schedule submitted to CCLD for this facility shows an overlap with the staff from the day program. Licensee also owns Claudia S. Cook Home #2 585002656.

Today, LPA spoke with Licensee Claudia Cook and Administrator Jeff Cook. Licensee has her administrator's certificate, but stated the main administrator is Jeff Cook. Jeff is waiting for the renewal of his administrator certificate that is in pending status. When he receives his certificate Licensee was instructed to submit paperwork appointing the administrator.

The staff schedule is there are two people who live at this facility and both are employed by the day program. Licensee and her husband also work for the day program and the residential facilities and cover when the two main staff can't work. The clients who live at this facility don't always meet at the day program and will leave from this facility to somewhere in the community and are accompanied by a staff person.

LPA requested a new staff schedule for this facility and the day program with an explanation of how the hours work for each by Monday, April 8, 2024.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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