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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000775
Report Date: 02/14/2025
Date Signed: 02/20/2025 10:08:20 AM

Document Has Been Signed on 02/20/2025 10:08 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DEBRA SHANDY RESIDENTIAL CARE HOMEFACILITY NUMBER:
347000775
ADMINISTRATOR/
DIRECTOR:		DEBRA SHANDYFACILITY TYPE:
735
ADDRESS:6165 LONGMONT WAYTELEPHONE:
(916) 966-6588
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 5DATE:
02/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Debra Shandy, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Todd Tryon arrived unannounced to the facility on 2/14/2025 to conduct a required 1-year annual inspection. LPA met with Licensee, Debra Shandy, and explained the purpose of the visit.

There are currently 5 clients living in the home.

LPA and Administrator toured the interior of the facility. Areas toured included clients rooms, bathrooms,, kitchen, garage and the common areas. Administrator Certificate is current. There was at least two days of perishable and 7 days of non-perishable foods. No immediate health, safety or personal rights violations observed. Smoke and carbon monoxide detectors installed. Fire extinguisher present.

LPA reviewed 2 of 3 staff files and 2 of 5 client files. Files include required documents and updates. CARE tool completed.

The facility appears to be in substantial compliance. No deficiencies cited.

Exit interview conducted..
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
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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