<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486801953
Report Date: 06/20/2023
Date Signed: 06/20/2023 05:25:40 PM

Document Has Been Signed on 06/20/2023 05:25 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:RICHARD'S HAPPY HOMEFACILITY NUMBER:
486801953
ADMINISTRATOR:TROY RICHARDFACILITY TYPE:
735
ADDRESS:254 DONEGAL COURTTELEPHONE:
(707) 448-2838
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 6CENSUS: 4DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:Ocie Richard, TIME COMPLETED:
05:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Required 1-year annual inspection and was greeted by Licensee, Ocie Richard. At the time of inspection there was one staff providing care and supervision to three clients, the other client was out of the facility on a trip.
LPA and Ocie Richard toured the facility and made the following observations: The facility was clean and a comfortable temperature. Signs were posted at the entry reminding visitors of Infection Control Precautions. Bathrooms were equipped with non-slip mats and grab bars. All residents their own hand washing supplies.
Facility has an activity room and residents are supervised while partaking in developed activities. Facility organizes transportation for medical services and activities. Bedrooms were furnished as required per regulation. Outdoor pool is covered and secured with required fencing.

LPA reviewed 3 staff records and 3 resident records. LPA and Ocie Richard observed that the facility has completed construction on an existing outbuilding, which will now be a second residence for staff. LPA advised that they submit copies of permits, facility sketch and facility plan, after final approval by PG & E.
Exit interview conducted with Ocie Richard.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2