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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000775
Report Date: 12/08/2021
Date Signed: 12/08/2021 04:55:52 PM

Document Has Been Signed on 12/08/2021 04:55 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:DEBRA SHANDY RESIDENTIAL CARE HOMEFACILITY NUMBER:
347000775
ADMINISTRATOR:DEBRA SHANDYFACILITY TYPE:
735
ADDRESS:6165 LONGMONT WAYTELEPHONE:
(916) 966-6588
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 5DATE:
12/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Debra Shandy, Administrator TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Administrator, Debra Shandy, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. The facility is a licensed Level 2 home vendorized through Alta California Regional Center. There are (5) clients who reside at the home. LPA observed (1) resident in the common area and the remaining (4) residents to be in their rooms. LPA observed Steven Shandy present as second staff.

LPA and Administrator toured the interior of the facility including the common areas, client bedrooms, bathrooms, kitchen, laundry/garage area observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various Covid posters throughout and updated visitation posters will be placed on the front door. Inside temperature was observed to be 71* F. Fire extinguisher last serviced 11/16/2021. LPA observed sufficient 2+day perishable and 7+day non-perishable food. LPA observed paper towels, soap, sanitizer, trash cans with lids and hand-washing posters in the bathrooms. LPA observed sufficient PPE supply to include goggles, masks, gowns, shields, gloves and sanitizer. LPA and Administrator discussed vaccination status of residents and staff as well as visitation protocols per PIN 21-40. Administrator to post signage the front entrance that masks, documentation of vaccination status or negative Covid test within 72 hours are required upon entry.

LPA obtained an updated copy of LIC308 during today's inspection.

There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator. Administrator was informed that a subsequent annual inspection could be conducted on/around 2/24/2022.



SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2021
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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