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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005404
Report Date: 03/03/2023
Date Signed: 03/03/2023 03:08:44 PM

Document Has Been Signed on 03/03/2023 03:08 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:CHOICE HARNEY ARFFACILITY NUMBER:
397005404
ADMINISTRATOR:CRYSTAL HEDRICKFACILITY TYPE:
735
ADDRESS:12436 E. HARNEY LANETELEPHONE:
(209) 333-3913
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 6CENSUS: 6DATE:
03/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Crystal Hedrick, AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Renee Campbell conducted an unannounced Annual 1-Year Required visit on this date. LPA met and toured with Administrator, Crystal Hedrick. The administrator currently holds a certificate (#6037841735) that expires on 12/01/2023.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 3 total bedrooms, of which 3 bedrooms are occupied by the clients and 0 bedrooms are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 70-degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 114-degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene products was available for clients. There is a minimum of 7-day nonperishables and 2-day perishables foods.

Smoke detectors are connected to the fire department and carbon monoxide alarms were in operating condition during visit. Fire extinguisher was last serviced on April 05, 2022. Emergency Disaster Plan was last posted on 02/2023. First aid kit was observed to be complete. Fire drill was last conducted on 02/09/2023.

Staff records were reviewed, and all staff have criminal record clearance or a criminal record exemption and hold a current first aid certificate.

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: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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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