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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 310305150
Report Date: 07/01/2024
Date Signed: 07/01/2024 03:41:43 PM

Document Has Been Signed on 07/01/2024 03:41 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: 14DATE:
07/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Gina WallaceTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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LPA visited the facility to check up on resident who went AWOL from the facility on 6/28/24. The resident goes for walks daily to the store. The physician report states resident is able to go out unassisted, and the resident always does so.

As LPA arrived, Mrs. Wallace was speaking with someone who said that the resident was located in Folsom, and was at a homeless shelter. The resident was located by police and taken to the shelter for food and water.

Mr. Wallace left immediately to go pick up the resident and bring him home; he will be taken to the Emergency Room to be checked. As far as is known, the resident is okay. Since the resident has missed several doses of medications, staff will ask to have resident evaluated regarding that.

It appears that the home reacted quickly and appropriately, and resident has been located.

No deficiencies were cited at this visit. Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2024
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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