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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700850
Report Date: 09/02/2022
Date Signed: 09/02/2022 04:05:36 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/02/2022 04:05 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:TWIN CITIES BOARD & CARE HOMEFACILITY NUMBER:
342700850
ADMINISTRATOR:LINDA MUSTINFACILITY TYPE:
735
ADDRESS:11098 TWIN CITIES ROADTELEPHONE:
(209) 745-4380
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 15CENSUS: 14DATE:
09/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Linda Mustin, AdministratorTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) R. Campbell conducted an unannounced Annual 1-Year Required visit on this date. LPA met and toured with Administrator, Linda Mustin. The facility’s fire clearance was approved for ambulatory clients..

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 18 total bedrooms of which 15 bedrooms are occupied by the clients and 3 bedrooms are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 78-degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 113-degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients. There is a minimum of 7-day nonperishables and 2-day perishables foods.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on August 12, 2022. First aid kit was observed to be complete.

Staff records were reviewed, and all staff have criminal record clearance or a criminal record exemption and holds a current first aid certificate.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2022
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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