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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003654
Report Date: 04/25/2024
Date Signed: 04/25/2024 12:57:58 PM

Document Has Been Signed on 04/25/2024 12:57 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:SUTTER HOUSEFACILITY NUMBER:
347003654
ADMINISTRATOR/
DIRECTOR:
SHERYL C ZONIOFACILITY TYPE:
735
ADDRESS:5721 SUTTER AVETELEPHONE:
(916) 972-8497
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 6DATE:
04/25/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Sheryl Zonio, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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Licensing Program Analysts (LPAs) Angela Hood and Kevin Mknelly arrived at the facility unannounced on 4/25/24 and met with the Administrator, Sheryl Zonio, to conduct a Required-1 Year Inspection.

LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four (4) bedrooms and three (3) bathrooms for resident use. LPAs observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 117.7 degrees F.

LPAs checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPAs observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPAs observed the outdoor area and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke and carbon monoxide detectors are operational. Fire extinguisher and first aid kit are maintained and ready for emergency use.

LPAs checked medication storage and found medications to be locked away and inaccessible to the residents. LPAs reviewed six (6) resident files and also reviewed three (3) staff files. Two residents' monies were checked for accuracy.

As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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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