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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701373
Report Date: 01/15/2025
Date Signed: 01/15/2025 03:33:54 PM

Document Has Been Signed on 01/15/2025 03:33 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:UCP ODYSSEYFACILITY NUMBER:
342701373
ADMINISTRATOR/
DIRECTOR:		PEFLEY, SHELLYFACILITY TYPE:
775
ADDRESS:3164 GOLD CAMP DR STE 250TELEPHONE:
(916) 565-7700
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 60CENSUS: 28DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:57 AM
MET WITH:Chris Dorsey, DesigneeTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 01/15/25, Licensing Program Analyst, (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct an annual inspection. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator. LPA met with Designee, Chris Dorsey, and a brief interview followed.

LPA began by comparing the staff roster of 21 employees to the list of those with background clearances in Guardian to ensure that all staff had been background cleared to work with the clients at this adult day program. All were in compliance at the time of this inspection.

LPA and the Designee toured the facility. LPA inspected all rooms and common areas including but not limited to: the kitchen, activities /arts and crafts room, nurse's office/ quiet room, computer/activities areas, a large common area for bowling and parachute play, storage area/garage, restrooms and offices. Designee pointed out areas that were more secluded for those clients who preferred not to participate in group activities. X number of clients participated in the program today.

All knives and sharps were locked and inaccessible to clients. Restrooms contained required grab bars, soap dispensers, paper towels and trash cans with lids.. LPA measured the hot water to ensure it was between the required 105 and 120 degrees Fahrenheit. The hot water measured 105 degrees and was in compliance at the time of this inspection. The thermostat was set at 71 degrees Fahrenheit and was also in compliance at the time of this inspection.

The fire extinguisher was last inspected on 09/05/24 by Fire Safety Fire Equipment Co. and was in compliance at the time of this inspection.

This facility does not provide meals, but it does provide snacks. This LPA inspected the food supply to
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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: 01/15/2025
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ensure that none of the food items were past their due date and that everything was appropriately packaged and stored properly.

LPA observed clients enjoying music and participating in tabletop activities. LPA later observed staff assisting clients with lunch.

This facility has a nurse on staff to assist clients with restricted health conditions. Additional staff were trained to assist as well and all training was documented and provided for LPA to review. All training was in compliance at the time of this inspection.

LPA reviewed the Medication Record and discussed administration, storage, and destruction procedures. All were in compliance at the time of this inspection. LPA audited 3 client medications stored in a locked cabinet and inaccessible to clients in care.

During this visit, this LPA requested the following:

LIC 500
LIC 9020
Updated 610D
Updates LIC 308
Copy of the lease
Copy of liability insurance

Staff and resident files were readily available for review during this visit. LPA reviewed Resident (R1) - (R3) and Staff (S1) - (S3) files. All were in compliance at the time of this inspection.

Per the California Code of Regulations, Title 22 no deficiencies were observed or cited during this visit.

Exit interview held, copy of report given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC809 (FAS) - (06/04)
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