500309303-9-25-2024-27-AS-RCAL-D9FRFD-20240925125900

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 500309303
Report Date: 09/25/2024
Date Signed: 09/25/2024 12:59:05 PM

Document Has Been Signed on 09/25/2024 12:59 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:	J & L GUEST HOME		FACILITY NUMBER:	500309303
ADMINISTRATOR:	RENEE LITTLE		FACILITY TYPE:	740
ADDRESS:	237 S ABBIE STREET		TELEPHONE:	(209) 527-2765
CITY:	EMPIRE	STATE: CA	ZIP CODE:	95319
CAPACITY:	32	CENSUS: 27	DATE:	09/25/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Renee Little, Administrator		TIME COMPLETED:	01:30 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) Renee Campbell arrived unannounced to conduct an annual inspection. LPA Campbell met with Renee Little, Administrator and Sarah Rico, House Manager and explained the purpose of the visit. Residents were observed throughout the facility socializing with peers and staff and eating. The facility was clear of debris and passages were unobstructed. LPA Campbell toured the facility and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas to ensure there are no safety hazards for residents. Furnishings were sufficient to meet the needs of residents. In each bedroom was a bed, tables, lamps and chair. No changes have been made to the floor plan in comparison to the facility sketch provided. All bedrooms are designed to be shared with two residents. Of the 20 staff files available, LPA Campbell was able to review 4 staff files and found them to be complete. Of the 27 client files, LPA Campbell was able to view 3 client files and the required documents were found to be included. All active staff were found to be cleared in Guardian. LPA Campbell reviewed the certificate for Administrator Renee Little that expired on 09/17/2024 and proof of renewal. In the physical plant, the temperature for a freezer is to be no higher then 0 degrees Fahrenheit. Of the 1 freezer found in the facility, the temperature was -1 degrees Fahrenheit. Refrigerator temperatures are to be no higher than 45 degrees Fahrenheit.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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: J & L GUEST HOME	FACILITY NUMBER: 500309303
	VISIT DATE: 09/25/2024

NARRATIVE

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Of the two refrigerators found on the premises, both had a temperature of 40 degrees Fahrenheit. Hot water must be between 105 and 120 degrees Fahrenheit. The temperature for the hot water in the resident bathroom was 116 degrees Fahrenheit.

The facility temperature was 72 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The backyard was toured by LPA Campbell and pathways and exits were found to be clear. Staff parking is in the back of the facility along with a locked tool storage, locked refrigerator and food pantry shed.

LPA Campbell observed first aid supplies, a fully-charged and up-to-date fire extinguisher that was last checked on 03/08/2024 and working carbon monoxide/smoke detectors that were tested by staff during the visit. LPA Campbell observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Campbell observed locked closets and cabinets for the storage of medication and P&I. LPA Campbell also observed locked storage areas for cleaning solutions in the staff bathroom.

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

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee Campbell	TELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

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