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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005277
Report Date: 03/01/2023
Date Signed: 03/01/2023 04:00:25 PM

Document Has Been Signed on 03/01/2023 04:00 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:PERSON CENTERED SERVICES, INC. #3FACILITY NUMBER:
397005277
ADMINISTRATOR:CHERYL ELLIOTTFACILITY TYPE:
775
ADDRESS:651 NORTH CHEROKEE LN., STE. ETELEPHONE:
(209) 466-2448
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 95CENSUS: 88DATE:
03/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Cheryl ElliottTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Renee Campbell conducted an unannounced Annual 1-Year Required visit on 03/01/2023. LPA met and toured with Director Deanna Smith. The facility’s fire clearance was approved for 03/29/2022.

LPAs inspected the facility, which included but not limited to the bathrooms, kitchen, activity area and the outside area of the facility. LPAs observed the facility to be free of odor, clean and in good repair. Outdoor space is provided and is free of hazards. There is a comfortable room temperature of 70 degrees Fahrenheit for clients in care. The motor vehicle used to transport clients is maintained in a safe operating condition. Grab bars were observed in bathrooms and throughout the facility. Food supply was stored and prepared in a healthful manner. The hot water temperature in the client bathroom measured 117 degrees Fahrenheit. All observed toilets and hand washing stations are maintained in a safe, sanitary, operating condition. There are no bodies of water or fire safety hazards observed. Carbon monoxide and smoke detectors found to be in working order. Centrally stored medications, toxins and sharp objects were locked and inaccessible to clients. LPAs reviewed client and staff files. All staff members have a current first aid and CPR. First aid kit was checked and is complete and disaster drill is current.

Smoke detectors are connected to the local fire department. Carbon monoxide alarms were in operating condition during visit. Fire extinguisher was last serviced on 07/22/2023. Emergency Disaster Plan was last posted on 01/22/2023. First aid kit was observed to be complete. Fire drill was last conducted on 02/21/2023. LPA reviewed staff record files and the facility has sufficient staffing to provide the services needed to meet the residents’ needs. All staff have criminal record clearance and are associated to the facility. All staff have current first aid training. The facility serves residents . LPA reviewed 8 of 8 residents’ files and no medication is kept on site or distributed.

No deficiencies were cited during this inspection.
Exit interview conducted. Appeal Rights and a copy of this report provided.




SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023
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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