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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317002200
Report Date: 12/04/2023
Date Signed: 12/05/2023 11:05:43 AM

Document Has Been Signed on 12/05/2023 11:05 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:YOUNG'S CARE HOMEFACILITY NUMBER:
317002200
ADMINISTRATOR:DENISE YOUNGFACILITY TYPE:
735
ADDRESS:24295 MILK RANCH ROADTELEPHONE:
(530) 346-7482
CITY:COLFAXSTATE: CAZIP CODE:
95713
CAPACITY: 6CENSUS: 4DATE:
12/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Denise YoungTIME COMPLETED:
01:45 PM
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On December 4, 2023 LPA Tryon visited the facility to do an annual visit using the CARE Tool. LPA met with Denise and Michael Young.
LPA toured the facility including kitchen, dining room, living room/common areas, bedrooms, bathrooms, laundry, and yard.
The home is very clean, nicely furnished and decorated and age appropriate for residents.
Food supplies were reviewed and are more than adequate to meet the requirement of 2 days perishable and 7 days non-perishable supplies. Medications are centrally stored and locked.
Smoke detectors and carbon monoxide detectors installed. Fire extinguishers present and charged.
LPA reviewed 2 of 2 staff files. Staff have taken appropriate classes, have finger-print clearances, physician reports, etc. Administrator certificates current.
LPA reviewed 2 of 4 resident files. Files include face sheets, updated physician reports, current IPPs and quarterly updates, client information, medical information, medication sheets, etc.
LPA completed the CARE Tool with licensee.
At this time the facility appears to be in overall compliance with the regulations.

No deficiencies were noted at this visit. Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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