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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004314
Report Date: 08/23/2024
Date Signed: 08/23/2024 12:45:14 PM

Document Has Been Signed on 08/23/2024 12:45 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:JO BIGORNIA HOME WILTONFACILITY NUMBER:
347004314
ADMINISTRATOR/
DIRECTOR:
MATTHEW ENRIQUEZFACILITY TYPE:
735
ADDRESS:11586 BADGER COLONY COURTTELEPHONE:
(916) 687-8425
CITY:WILTONSTATE: CAZIP CODE:
95693
CAPACITY: 6CENSUS: 6DATE:
08/23/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Thelma CasugayTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Health and Safety check on residents of the facility on 8/23/24 at 11:00am. LPA met with Thelma Casugay and stated the purpose of the visit. On 8/22/24, there was a grass fire in the area of Walmort Road and Badger Creek Lane at which time evacuation orders were in effect. The facility Well was down as there was no power or water. The Licensee put into effect their emergency disaster policy. The residents were relocated to a safer area, medications were being prepared to be delivered by the pharmacy, arrangements were made for residents who attended day program to arrive safely to the relocation site. There were 6 staff working during the relocation to ensure safety for residents.

Within a few hours the evacuation order and road closures were lifted. However, upon a return to the facility for inspection, the Administrator observed that the Well-tanks had burned which will be repaired today by Nix Water Company. In addition, SMUD is working with Mr. Electric to inspect the electricity and sprinklers before the residents return to the facility. The Administrator has estimated that the return to the facility would depend on the swift work of SMUD/Mr. Electric and Nix Water Company. It could be possibly by Monday 8/26/24. At this time all residents are away from the facility for safety reasons.

Based on continuous communication with the Administrator and observations there seem to be no safety concerns at the relocation site at this time. The Licensee will look into having the home cleaned by a cleaning service as during the evacuation was lifted it was also stated the air quality is poor and smoke is still present which possibly includes ashes for the safety of the residents respiratory status. At this time, the staff is trying to ventilate the home as much as they can. During this visit Mr. Electric and Nix arrived.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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