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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 310305150
Report Date: 04/06/2023
Date Signed: 04/07/2023 10:27:48 AM

Document Has Been Signed on 04/07/2023 10:27 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:TAYLOR'S RESIDENCEFACILITY NUMBER:
310305150
ADMINISTRATOR:DONALD AND GINA WALLACEFACILITY TYPE:
735
ADDRESS:375 PLACER STREETTELEPHONE:
(530) 885-7306
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 15CENSUS: 14DATE:
04/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Gina WallaceTIME COMPLETED:
01:15 PM
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On 4/6/2023 LPA Tryon visited the facility to conduct an annual inspection visit,. LPA met with licensee Gina Wallace.

LPA reviewed the ARF CARE Tool with licensee.
LPA then toured the facility with Mrs. Wallace, including common areas, bedrooms, hallways, bathrooms, yard and kitchen.

The home is appropriately furnished. Food supplies are appropriate to meet the requirement of 2 days perishable and 7 days non-perishable.

Smoke detectors/carbon monoxide detectors/sprinkler system installed; fire extinguishers present.

Medications are centrally stored and locked. Potentially hazardous substances and items are secured.

Facility keep appropriate staff and resident files.

Disaster/Infectious Disease plans in place.

At this time, the facility appears to be in substantial compliance with the regulations.

No deficiencies cited at this visit. Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2023
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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