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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700850
Report Date: 11/07/2024
Date Signed: 11/07/2024 03:46:25 PM

Document Has Been Signed on 11/07/2024 03:46 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:TWIN CITIES BOARD & CARE HOMEFACILITY NUMBER:
342700850
ADMINISTRATOR/
DIRECTOR:
LINDA MUSTINFACILITY TYPE:
735
ADDRESS:11098 TWIN CITIES ROADTELEPHONE:
(209) 745-4380
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 15CENSUS: 15DATE:
11/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Katherine BooneTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with facility staff Katherine Boone, and explained the purpose of the visit. LPA Valerio contacted Administrator Linda Mustin via cell phone, which designated Kathy to carry out the visit.

The facility is currently undergoing a pest control service for bed bugs. The service was completed on 11/06/2024. A second service will be completed on 11/08/2024. According to the Administrator Linda, the staff and Administrator staff are working diligently to ensure resident rooms are vacuumed and cleaned after the service takes place. Residents are not displaced from there rooms as the service is completed prior to their normal sleep hours. Program services are continuing as normal. Administrator Linda to informed LPA Valerio when the pest control services have been completed.

LPA Valerio observed the facility had an adequate food supply to meet Title 22 requirements. Resident bathrooms were observed to be in working condition and stocked with toilet paper, paper towels, and hand soap. Common areas were observed to be fully furnished. The exterior area was observed to have chairs for sitting or outdoor visitation. Medications and sharps were observed to locked and inaccessible to residents in care. Residents were observed in the living room area, completing daily chores, on their electronics, or walking around the facility. Staff were observed to be preparing dinner. The facility conducted their last fire drill on 10/2024. The fire extinguishers were observed to be fully charged with a maintenance check of August 16, 2024.

LPA Valerio requested the following annual documentation be sent to LPA Valerio: LIC 500, LIC 308, LIC 610, copies of pest control service invoices, copies of staff first aid certificates .

Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited today. An exit interview was held, and a copy of the report was left at the facility with designated staff.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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