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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700783
Report Date: 09/05/2024
Date Signed: 09/05/2024 10:09:53 AM


Document Has Been Signed on 09/05/2024 10:09 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:7117 MAIN, LLCFACILITY NUMBER:
342700783
ADMINISTRATOR:GLADYS GASTAFACILITY TYPE:
740
ADDRESS:7117 MAIN AVETELEPHONE:
(707) 592-4004
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 4DATE:
09/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Staff, Sevrena MillerTIME COMPLETED:
10:15 AM
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On 09/05/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to conduct a Plan of Correction (POC) case management and met with Staff, Sevrena Miller and explained the purpose of the visit.

On 08/20/24, LPA cited the facility on CCR regulation, 87303(e)(2) -Maintenance and Operation -and facility should have submitted all required documents to clear POC by POC Due Date of 09/04/24. Licensee/administrator did not ensure that the POC was corrected upon Due Date of 09/04/24. Furthermore, LPA checked water temperature in the kitchen during today's visit and the reading was 145.8 degree F which is not within required range ( 105-120 degre F ). On today's date, LPA will be assessing a Civil Penalty of $100/day from 09/04/24-09/05/24 (Total - $200.00) for this violation and will continue to accrue until POC is corrected.

Civil Penalties were assessed during this visit for failure to correct the above violations by POC Due Date. Exit Interview was conducted, Appeal rights were provided, and a copy of this report was left at the facility.







SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024
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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