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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700283
Report Date: 02/18/2025
Date Signed: 02/20/2025 10:08:56 AM

Document Has Been Signed on 02/20/2025 10:08 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HARMONY HOUSEFACILITY NUMBER:
312700283
ADMINISTRATOR/
DIRECTOR:
WAUTLET, BRANDONFACILITY TYPE:
735
ADDRESS:11080 B AVENUETELEPHONE:
(530) 886-3470
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 28CENSUS: 23DATE:
02/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Brandon WautletTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 2/18/2025 LPA Tryon visited the facility to complete an annual required visit. LPA met with Administrator Brandon Wautlet. Facility currently has 23 residents.

LPA toured the facility including common areas, living areas, kitchen, dining room, resident bedrooms, bathrooms, offices, medication room, outside and recreation areas. The facility is clean, well-furnished and in good condition. Bedrooms are furnished with appropriate furniture as per regulation. Kitchen is well-stocked with adequate supplies. There are at least 2 days of perishable food and 7 days of non-perishable food. Medications are locked and Centrally Stored logs and MARS are updated.

LPA reviewed 4 client files and 4 staff files. Files appear to contain required documentation.

Fire system is installed and is checked by company . System was last checked on July 21, 2024.
Fire extinguishers present and charged.

LPA interviewed 4 residents and 1 staff.

LPA reviewed the CARE Tool with Mr. Wautlet.

At this time, the facility appears to be in substantial compliance with Title 22 Regulations and the Health and Safety Code.

No deficiencies were cited.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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