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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317002200
Report Date: 10/09/2024
Date Signed: 10/09/2024 02:55:34 PM

Document Has Been Signed on 10/09/2024 02:55 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:YOUNG'S CARE HOMEFACILITY NUMBER:
317002200
ADMINISTRATOR/
DIRECTOR:		DENISE YOUNGFACILITY TYPE:
735
ADDRESS:24295 MILK RANCH ROADTELEPHONE:
(530) 346-7482
CITY:COLFAXSTATE: CAZIP CODE:
95713
CAPACITY: 6CENSUS: 4DATE:
10/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Denise Young, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 10/9/2024 LPA Tryon visited the facility to do an annual visit. LPA met with Denise Young, Administrator.
LPA toured the facility including common areas, kitchen, storage, bedrooms, bathrooms, yard. The home is very clean,nicely furnished. Fire extinguisher checked annually and charged. Smoke detectors installed. Carbon monoxide detector installed. Hot water tested and was at 118 degrees F, within the Title 22 range of 105 to 120 degrees F.
Food supplies are appropriate to meet the requirement of 2 days perishable and 7 days non-perishable. No hazards noted in the facility.

LPA reviewed the CARE Tool with Administrator.
LPA reviewed 2 of 4 resident files and 2 of 2 staff files. Files include required documents.
LPA interviewed one staff and 2 residents.

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: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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