<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003654
Report Date: 04/07/2022
Date Signed: 04/07/2022 01:06:56 PM

Document Has Been Signed on 04/07/2022 01:06 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:SUTTER HOUSEFACILITY NUMBER:
347003654
ADMINISTRATOR:SHERYL C ZONIOFACILITY TYPE:
735
ADDRESS:5721 SUTTER AVETELEPHONE:
(916) 972-8497
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 6DATE:
04/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Paz Yntela, caregiver and Angelita Zonio, caregiver TIME COMPLETED:
01:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Paz Yntela and Angelita Zonio, caregivers 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. 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: KN95 mask. The facility is a licensed home that is vendorized through Alta California Regional Center. There are (6) clients who reside at the home. LPA observed (5) clients in the common area and (1) client is at day program. Sheryl Zonio, Administrator, called at approximately 12:20 pm, as she is currently out of town. Administrator has authorized caregivers to act on her behalf today during the inspection.

LPA and caregiver, Paz, toured the interior of the facility including the common areas, client (6) bedrooms, (2) bathrooms, kitchen, laundry, second activity room/office and observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. Also at the location are (2) separate small houses where caregivers stay. Gates are not locked from the inside. There is no pool on site.
LPA observed various Covid posters throughout as well as other required postings. Administrator certificate #6014337735- exp 3/22/2022 is pending renewal. Inside temperature was observed to be 74* F. Fire extinguisher last serviced 5/15/2021- to be re-serviced by 5/15/2022. LPA observed monthly fire drill documentation posted. LIC610E was last updated 9/1/2021. LPA observed locked toxins, medications and sharps and sufficient 2+day perishable/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 on hand including an emergency PPE kit on hand.
LPA requested an updated copy of LIC500 by 4/15/2022. There were no deficiencies observed during today's inspection. Exit interview. Copy of report left with caregivers who are authorized to sign/accept the report.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2022
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 1