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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701398
Report Date: 06/26/2024
Date Signed: 06/26/2024 11:47:52 AM

Document Has Been Signed on 06/26/2024 11:47 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:DREAMERS' HEARTHFACILITY NUMBER:
342701398
ADMINISTRATOR/
DIRECTOR:
SUGANOB, JESSIEFACILITY TYPE:
735
ADDRESS:11859 AUTUMN SUNSET WAYTELEPHONE:
(916) 225-8423
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY: 4CENSUS: 0DATE:
06/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Jesse SuganobTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 6/26/24 Licensing Program Analyst (LPA) Kimberly Viarella made an announced visit to conduct a prelicensing inspection. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator (DFA). LPA met with Jesse Suganob. No clients were residing at the facility at the time of inspection.

The DFA began the tour of the facility by showing the LPA that all medications and client files were stored in a locked closet to the left of the front entrance and adjacent to the dining room. The DFA provided the LPA with a sample of a client file and all was in order. The tour continued throughout this 4 bedroom, 2 bathroom home. All client rooms contained the required bed, chest of drawers, closet, and lighting to meet regulation requirements. All bedrooms had doors with locks to provide clients with privacy. Both bathrooms contained paper towels and soap and the hot water measured at 115.5 degrees Fahrenheit and was in compliance at the time of inspection.

LPA inspected the laundry room. All detergents and cleaners were under the sink in a locked cabinet. LPA observed enough linens and towels stored in the laundry room and in cabinets adjacent to the laundry room to meet the needs of future residents in care.

LPA inspected the kitchen and all knives and sharps were in a locked drawer and inaccessible to future clients. LPA observed enough cutlery, pots, pans, and cups for future residents. The refrigerator and pantry were stocked with enough perishable food for 2 days and non-perishable food for 7 days.

LPA observed sample menus for future residents posted on the refrigerator. All dish soap and cleansers were in a locked cabinet under the sink.

There were a total of 3 fire extinguishers: 1 in the kitchen, 1 in the hall, and 1 in the garage. All were inspected by Sacramento Fire Extinguisher Company on 01/19/24.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: DREAMERS' HEARTH
FACILITY NUMBER: 342701398
VISIT DATE: 06/26/2024
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LPA observed games stored on shelves in the activity room, and the DFA showed the LPA a list of community organizations that also provided activities for residents.

LPA observed the following signs posted throughout the facility: Emergency plan with appropriate phone numbers, facility sketch with evacuation route, resident rights, grievance procedures, If You See Something, Say Something, and the state employee rights poster with wage requirements.

LPA inspected the exterior of the facility. LPA observed no outbuildings or bodies of water. All screens and gutters, along with the fence surrounding the property were in good repair. There were also tables and chairs with umbrellas that provided shaded seating.

There were no deficiencies observed during this visit.

This facility passed its prelicensing inspection and the LPA then conducted Comp III.

A copy of this report was provided. Exit interview
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
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