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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700887
Report Date: 11/15/2023
Date Signed: 11/15/2023 01:36:37 PM

Document Has Been Signed on 11/15/2023 01:36 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:EMMA & JOYCE DIALA UNIQUE HOMEFACILITY NUMBER:
342700887
ADMINISTRATOR:DIALA, MANUELFACILITY TYPE:
735
ADDRESS:7354 ALDEN WAYTELEPHONE:
(916) 821-4214
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 4CENSUS: 4DATE:
11/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:MANUEL DIALATIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required Annual Inspection Visit. LPA met with administrator and explained the purpose of the visit. Administrator certificate #6035710735 expires 4/26/2024.

This facility is a single story building licensed to serve four (4) ambulatory residents of which 1 may be non-ambulatory at any given time. LPA and administrator toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 113.3 degrees Fahrenheit in kitchen sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers were last serviced on 4/10/2023. Smoke and carbon monoxide detectors are in compliance with fire safety. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. First aid kit was checked and is complete.

LPA reviewed four resident files and four staff files. A review of staff records indicates that all facility staff & other individuals who require caregiver background checks are fingerprint cleared and to the facility. LPA verified staff training for staff file reviews and all four staff have current First Aid Certificates.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, no citations were issued during today's visit.

Exit interview held with administrator. A copy of report and LIC 811 (Confidential Names) given at the conclusion of the visit.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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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