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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500300344
Report Date: 11/07/2023
Date Signed: 11/07/2023 12:12:25 PM

Document Has Been Signed on 11/07/2023 12:12 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:HOWARD PREPFACILITY NUMBER:
500300344
ADMINISTRATOR:CARLA STRONGFACILITY TYPE:
775
ADDRESS:1424 STONUM ROADTELEPHONE:
(209) 538-4000
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 320CENSUS: 19DATE:
11/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Brandie Smith, Program ManagerTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPA's) Renee Campbell and Ruth Wallace conducted unannounced required 1 year annual inspection on 11/07/23 at approximately 8:30 am. LPA Campbell met with Program Manager Brandie Smith and Assistant Executive Director Jesus Munoz and explained the purpose of the visit.

LPA Renee Campbell reviewed four resident files and three staff files. All staff were fingerprint cleared and have current first aid certificates. LPA's toured the facility with program manager and inspected classrooms, the kitchen, bathrooms, storage and property. Furniture and furnishings were sufficient to meet the needs of clients. The facility temperature was 76 degrees Fahrenheit, which is within the required range of 73 to 85 degrees.

LPA Renee Campbell observed first aid supplies, a fully charged and up-to-date fire extinguisher dated 04/11/23. Carbon monoxide and smoke detectors were linked to the fire department. Per Program Manager Brandie Smith, the day program provides no meals or snacks. LPA Renee Campbell observed a locked cleaning room for storage of cleaning solutions.

LPA Campbell interviewed two staff members. The residents were out in the community.
No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Brandie Smith.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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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