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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297003934
Report Date: 04/04/2024
Date Signed: 04/04/2024 02:31:34 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:ALL-STAR PROGRAMSFACILITY NUMBER:
297003934
ADMINISTRATOR/
DIRECTOR:		COOK, JEFFERY C.FACILITY TYPE:
775
ADDRESS:10140 WILD TURKEY LANETELEPHONE:
(530) 432-6564
CITY:SMARTSVILLESTATE: CAZIP CODE:
95977
CAPACITY: 24CENSUS: DATE:
04/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Jeff 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 staff who work here also work for Claudia S. Cook 297001009 and Claudia S. Cook Home #2 585002656. The staff schedule submitted to CCLD for this facility shows an overlap with the staff from the Adult Residential Facilities.

Today, LPA spoke with Co-Licensee Jeff Cook. The other Co-Licensee is Jean-Claude Cook.

The staff schedule submitted for the day program conflicts a little with the adult residential facilities. The clients who attend the day programs don't always meet at this location for the their outings so the building sometimes is not used for an extended period. When that occurs the clients are attending off-site program outings. The staff schedule conflicts because it shows the staff who live and work at the adult residential facilities are there 24/7 and the day program schedules shows they are working at the day program when they stated they are at the adult residential facility.

LPA requested a new staff schedule for the adult residential facilities 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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