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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 310305150
Report Date: 04/18/2024
Date Signed: 04/18/2024 03:55:17 PM

Document Has Been Signed on 04/18/2024 03:55 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:TAYLOR'S RESIDENCEFACILITY NUMBER:
310305150
ADMINISTRATOR/
DIRECTOR:		DONALD AND GINA WALLACEFACILITY TYPE:
735
ADDRESS:375 PLACER STREETTELEPHONE:
(530) 885-7306
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 15CENSUS: 13DATE:
04/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Gina WallaceTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 4/18/2024 LPA Tryon visited the facility to conduct an annual visit. LPA met with licensee Gina Wallace.
LPA toured the facility including common areas, kitchen, dining area, bedrooms, bathrooms, hallways, staff area, yard.
The facility is appropriately furnished and clean.
Smoke detectors/carbon monoxide detectors installed, fire extinguishers charged, were just charged last week.
Food supplies were appropriate to meet the requirement of 2 days perishable and 7 days non-perishable.
Medications are centrally stored and locked.
LPA reviewed 2 resident files which contain required information.
Staff files contain appropriate information.
LPA interviewed staff person Gina.
Residents did not wish to participate.
LPA reviewed the CARE Tool with Mrs. Wallace.

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

No deficiencies were cited at this visit.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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