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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701238
Report Date: 04/15/2024
Date Signed: 04/15/2024 01:05:46 PM

Document Has Been Signed on 04/15/2024 01:05 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:STAYPOINT RESIDENTIALFACILITY NUMBER:
342701238
ADMINISTRATOR/
DIRECTOR:
OGENAH, OGIATOR MICHEALFACILITY TYPE:
735
ADDRESS:167 DANNY DRTELEPHONE:
(408) 373-7750
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 6CENSUS: 4DATE:
04/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:33 AM
MET WITH:Facility StaffTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual required inspection. LPA met with facility staff Janet Eke, and explained the purpose of the visit. Facility staff informed Administrator of the visit and confirmed that facility staff could carry out the visit.

LPA Valerio and Facility staff toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed resident bedrooms, resident bathrooms, common areas, kitchen area, staff area, and exterior area. LPA observed 3 resident bedrooms, all of which had 2 residents per room. LPA observed the rooms to be fully furnished and without odors. Resident bathrooms were clean and free from debris. Common areas were fully furnished, clean, free from debris, and plenty of areas for activities or visiting. LPA observed fire detectors, carbon monoxide detector, heating/air supply, and fire extinguisher to be in working condition. Facility vehicle appeared to be in working condition. The fire extinguishers were last serviced on 08/10/2023. Facility thermostat was observed to have a deliver a room temperature of 66 degrees F. Hot water measured at 118.0*F, which is within the regulatory range of 105 - 120 degree F. The exterior area was observed. The shed located in the backyard is being utilized as the resident's gym area. The backyard was observed to have a large shaded sitting area, a basketball hoop, and a clear exit walk way. LPA observed one staff on shift, which was assisting residents with meal preparation, medication administration, and appointments. Residents that were home were observed taking a nap, outside in the backyard, eating lunch, and talking to staff. Other residents went out on an outing for the day.
LPA reviewed 2 staff files and 2 resident files. Staff files were observed to be current with necessary training. All staff were observed to be fingerprint cleared and associated to the facility. Resident files were observed to be complete with required annual documents. LPA requested copies of the following documentation be sent by 04/22/2024: LIC 500, LIC 308, LIC 610, and Surety Bond

Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2024
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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