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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000775
Report Date: 02/15/2024
Date Signed: 02/15/2024 02:23:37 PM

Document Has Been Signed on 02/15/2024 02:23 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: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:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:37 PM
MET WITH:Debra ShandyTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to the facility on 2/15/2024 to conduct a required 1-year annual inspection. LPA met with Administrator, Debra Shandy, and explained the purpose of the visit.

The facility is licensed for six (6), today's census is five (5).

During today's inspection, LPA and Administrator toured the interior of the facility to ensure the health and safety of clients in care. LPA observed the presence of 5 clients in care. Areas toured included but not limited to: three clients room, one bathroom, kitchen, garage and the common areas. LPA observed Administrator Certificate #6001229735 to be posted and current. LPA observed the facility to have 2+ days of perishable and 7+ days of non-perishable foods. No immediate health, safety or personal rights violations observed.

LPA and Administrator discussed the possibility of facility closure in the future. LPA informed Administrator of 60 day notice for closure. Administrator informed LPA that there is a client turning 60 soon which will skew age 60+ percentage. LPA informed Administrator to submit an exception request to Licensing for approval. Administrator reported no concerns at the facility at this time. LPA informed Administrator LPA will forwarded the information regarding the exception request to Administrator.

LPA completed file review for personnel and client files. CARE tool completed with Administrator and facility is found to be in substantial compliance. No deficiencies cited.

Exit interview conducted and a copy of the report will be emailed to Administrator.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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