500307165-9-5-2024-27-AS-RCAL-D8TSVL-20240905141255

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 500307165
Report Date: 09/05/2024
Date Signed: 09/05/2024 02:13:06 PM

Document Has Been Signed on 09/05/2024 02:13 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:	LITTLE'S GUEST HOME		FACILITY NUMBER:	500307165
ADMINISTRATOR/ DIRECTOR:	LAURA WOODING		FACILITY TYPE:	735
ADDRESS:	213 S ABBIE STREET		TELEPHONE:	(209) 524-2163
CITY:	EMPIRE	STATE: CA	ZIP CODE:	95319
CAPACITY: 22		CENSUS: 19	DATE:	09/05/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Sabrina Mendez, House Manager		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

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On 09/05/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to conduct an Annual Inspection. LPA Campbell was met by House Manager Sabrina Mendez and explained the purpose of the visit. Administrator Denise Wooding was present as well.

Upon entry through the rear entrance, LPA Campbell observed an unobstructed hallway with doors lining the hallway for clients bedrooms. Several bedroom doors were open. In each bedroom, two beds, a closet and the required accessories were observed. Per the House Manager, a resident was mowing the lawn during the visit. The facility is a one floor structure with 11 bedrooms and four bathrooms. Currently there are 19 clients present and 11 staff working in the facility. There can be up to 6 non-ambulatory clients, but currently, all 19 clients are ambulatory. At night, staff are to be awake to assist clients.

During the facility tour, LPA Campbell observed an unlocked knife drawer and 6 refrigerators that did not have a thermometer to verify temperature. Facility menus were posted over the oven. First aid kits and client medication was observed to be locked and inaccessible from clients. Cleaning products and other household equipment such as steamers for detailing were locked in the hallway beside the kitchen. The thermostat was set at 76 degrees Fahrenheit and the hot water in the bathroom was measured at 108 degrees Fahrenheit. The pantry contained non-perishables, two refrigerators and excess medication used to refill prescriptions for clients.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LITTLE'S GUEST HOME	FACILITY NUMBER: 500307165
	VISIT DATE: 09/05/2024

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The backyard provides seating and shade for clients. Along with two refrigerators on the patio, there was also a soda machine for client use. A shed with a mower, paint and other equipment was observed to be locked and inaccessible to clients. During the inspection, LPA Campbell observed staff urging clients to wash their hands before lunch. Clients then had lunch that consisted of peanut butter and jelly sandwiches, chips, cookies, bananas and soda. Clients were observed making substitutions to their meal or asking for something different. During the inspection, facility staff obtained thermometers for the refrigerators and installed a lock for the sharps drawer as requested by LPA Campbell. Linen was stored in cabinets in the entryway to the dining room. A test was done for the smoke alarms which were found to be functional. Bathrooms were found to be clean and in good repair.

Of the 11 staff, 2 of their staff files were reviewed and found to be complete. Of the 19 clients, 3 of their files were reviewed. One client file had no signed Personal Rights form. Staff reviewed the document and had the client sign it, in LPA Campbell's presence.

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, no deficiencies are being cited. An exit interview was conducted with House Manager Sabrina Mendez and a copy of this report was provided.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC809 (FAS) - (06/04)

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