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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002804
Report Date: 11/30/2023
Date Signed: 11/30/2023 12:19:18 PM

Document Has Been Signed on 11/30/2023 12:19 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ODYSSEY LIFE CENTERFACILITY NUMBER:
345002804
ADMINISTRATOR:PENMAN, SHELBYFACILITY TYPE:
775
ADDRESS:283 IRON POINTTELEPHONE:
(916) 988-0258
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 30CENSUS: 13DATE:
11/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Site Coordinator- Juanaila RyanTIME COMPLETED:
12:30 PM
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On 11/30/23 Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Talwinder Bains arrived at the facility unannounced to conduct an annual one year inspection utilizing the care tool. LPAs met with Site Coordinator Juanaila Ryan (S1) and explained the purpose of the visit.

LPAs and S1 conducted a tour of the interior and exterior of the facility. Areas toured included but
not limited to: common areas, restrooms, kitchen area, supply room, play area, outside area.

LPAs observed Smoke and Carbon monoxide detectors are operational. Appropriate lighting was present throughout the facility. Fire extinguisher was inspected January 10th 2023 and was ready for emergency use. The temperature in the facility is at 69 degrees. Water temperature was detected at 120 degrees Fahrenheit, which was in required range. Facility conduct monthly fire drills as required.

LPAs conducted a file review of 2 staff members and 4 clients records. LPA observed that all files have current documents as well as the needed documents. Per S1, facility does not administer any medication to clients at this time.

LPAs and S1 completed the Care Tool together and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility with S1.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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