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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701373
Report Date: 01/17/2024
Date Signed: 01/17/2024 11:34:18 AM

Document Has Been Signed on 01/17/2024 11:34 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:UCP ODYSSEYFACILITY NUMBER:
342701373
ADMINISTRATOR:PEFLEY, SHELLYFACILITY TYPE:
775
ADDRESS:3164 GOLD CAMP DR STE 250TELEPHONE:
(916) 565-7700
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 60CENSUS: 0DATE:
01/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shelly Pefley TIME COMPLETED:
11:45 AM
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On 01/17/24 Licensing Program Analyst (LPA) Kimberly Viarella made a scheduled visit to this facility to conduct an inspection due to a change of location for this program. LPA identified herself, stated the purpose of the visit and met with the Designated Facility Administrator (DFA) Shelly Pefley. Currently there are no clients attending a program at this facility.

LPA and DFA toured the interior of the facility. There were 3 chairs and a small table in the reception area. All other rooms were devoid of furniture and furnishings at this time, as everything will be relocated from its current location on 01/27/24.

LPA confirmed the facility sketch submitted matched the layout of the building. LPA observed 3 fire extinguishers that were inspected by Jorgenson Co on 11/15/23. LPA confirmed the fire alarm system was hardwired to the fire department. LPA also observed lit exit signs where appropriate.

LPA inspected 6 bathrooms: 2 were labeled single sex, 2 were labeled all-gender, and 2 were labeled male/female, 2 were large enough to accommodate changing tables and all 6 were handicap accessible. 3 bathrooms; the 2 located to the right of reception and 1 to the left and farthest from the front of the building, need to have their hot water fixed as they will not reach the minimum required temperature. The DFA stated that the work should be completed by 01/25/24. The DFA agreed to contact the LPA upon completion. LPA tested the hot water in the food prep area and one of the other bathrooms and the temperature registered 109 and 111.8 degrees Fahrenheit respectively and complied with regulations. All bathrooms were equipped with grab bars, as well as soap and paper towel dispensers.

LPA observed 2 locked storage areas that had access to loading bays, and a locked laundry room that will serve as additional storage. LPA observed a kitchen/food prep area that contained a sink and dishwasher along with counter space along 2 walls. The DFA stated that hotplates, a microwave and a convection oven
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: UCP ODYSSEY
FACILITY NUMBER: 342701373
VISIT DATE: 01/17/2024
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will be moved into this space on 01/27/24. LPA noted that none of the drawers were equipped with locks and the DFA stated that sharps were kept in a locked office at their current location and that would be the same policy at this location as well. LPA was also shown a designated room for the Nurse's office and/or isolation if a client was found to be sick and potentially contagious.

LPA was shown 2 large classroom spaces as well as 3 offices and a conference room. LPA was also shown
a third room that had a bay door where clients would be dropped off / picked up. The DFA stated that area would also be utilized as a classroom space as well as for an exercise area.

LPA and DFA conducted an exterior tour of the facility. UCP Odyssey was located on the end of a row of businesses in this business park. There was no green space or outbuildings allotted this facility. The area surrounding the building was clear of debris and allowed access for client pick up and drop off.

This facility has been found to be in compliance at this time.

A copy of this report was provided.

Exit interview
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
LIC809 (FAS) - (06/04)
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