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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920023
Report Date: 10/26/2023
Date Signed: 10/26/2023 03:33:08 PM


Document Has Been Signed on 10/26/2023 03:33 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:DAD'S PLACE, INC.FACILITY NUMBER:
315920023
ADMINISTRATOR:MURRAY, KATHERINE S.FACILITY TYPE:
740
ADDRESS:8100 HORSESHOE BAR RD.TELEPHONE:
(530) 718-0932
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY:6CENSUS: 5DATE:
10/26/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Katie MurrayTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Thursday October 26, 2023 to conduct an unannounced prelicensing visit.

LPA toured the facility with Administrator Katie and Manager Tyler. The Compliance and Regulatory Enforcement Tool was used during today's inspection. This facility has a fire clearance for 5 nonambulatory and one bedridden resident. Facility has all required postings in the hallway. The following areas were inspected for compliance: kitchen, backyard, resident apartments, resident bathrooms, and common areas. Facility has current fire extinguishers and a full first aid kit. Medications are kept locked in a cabinet in the hallway. Cleaning chemicals and knives/sharps are kept locked and inaccessible to residents. Resident binders and staff records are kept in a locked staff area.

Component III has been completed at this time.

The facility appears to be in substantial compliance and ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. An exit interview was conducted with Administrator and a copy of this report will be left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
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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