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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397202947
Report Date: 06/13/2024
Date Signed: 06/13/2024 11:25:07 AM

Document Has Been Signed on 06/13/2024 11:25 AM - 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:NEW HOPE GUEST HOME - TRETHEWAYFACILITY NUMBER:
397202947
ADMINISTRATOR/
DIRECTOR:
FELIX, ROBERT A.FACILITY TYPE:
735
ADDRESS:17451 NO. TRETHEWAY ROADTELEPHONE:
(209) 333-9322
CITY:LOCKEFORDSTATE: CAZIP CODE:
95237
CAPACITY: 6CENSUS: 5DATE:
06/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Robert Felix and Joan Talaroc TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 06/13/2024 Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Robert Felix and Joan Talaroc and explained the purpose of the visit.

LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds a current certificate and expires on 05/15/2025. The facility is licensed for six ambulatory clients. There are currently five clients who reside at this facility.

The LPA Martinez toured the facility with Robert Felix and Joan Talaroc on 06/13/2024 at 10:30 AM

The facility's last well water laboratory test was on March 15, 2023. The facility has an emergency disaster plan, and has an infection control plan. LPA Martinez reviewed five client files and five staff files. In addition, LPA Martinez reviewed three medication administration records, and one PNI file. All of the facility files were maintained. The last fire Drill was on May 08, 2024. The smoke detectors, carbon detectors, and fire extinguishers are in good repair. During today's annual inspection, the facility bedrooms, bathrooms, laundry room, and kitchen were sanitary and furnished. The facility also has an shaded patio for client use. The facility water temperature measured at 105 degrees, and the facility temperature measured at 70 degrees. The facility has a public telephone, and a first aid kit.

Based on this annual inspection, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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