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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500332206
Report Date: 02/17/2022
Date Signed: 02/17/2022 04:02:00 PM

Document Has Been Signed on 02/17/2022 04:02 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:DEL RIO GUEST HOMEFACILITY NUMBER:
500332206
ADMINISTRATOR:SILER, DOROTHYFACILITY TYPE:
735
ADDRESS:2841 PATTERSON RDTELEPHONE:
(209) 869-2420
CITY:RIVERBANKSTATE: CAZIP CODE:
95367
CAPACITY: 15CENSUS: 10DATE:
02/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Saudia KingTIME COMPLETED:
04:15 PM
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Licensing Program Analysts (LPAs) Maja Jensen and Avelina Martinez made an unannounced visit on 2/17/22 and met with Administrator Saudia King. LPA s explained the purpose of today's visit. The current census is 10. The Administrators certification was valid through August of 2022.

LPAs toured the facility with Administrator Saudia King. Interior and exterior were observed. Exterior was clear of obstructions and well maintained. Interior kitchen was observed to be clean. A seven day supply of non-perishable food was observed and a 2 day supply of perishable food was observed. Toxins were observed to be kept locked and inaccessible to residents. Water temperature was measured in kitchen at 109 degrees which is within the required range of 105-120 degrees. Water temperature in 1 client bathrooms was measured to 108 degrees which also falls within the required range. Resident bathroom was observed to have a toilet that required a new bottom seal, a torn screen and baseboards that were separating from the wall. Carbon monoxide detectors and fire alarms were checked and functional. Fire extinguishers were mounted and charged with the last inspection date January of 2022. The facility was at a comfortable temperature for Clients in care. There was enough staff to meet the needs of the clients in care.

LPAs reviewed 1 client file and 1 staff file. Required documentation was observed and in order.

LPAs issued a technical violation for bathroom maintenance.

Based on the observations noted, the facility appears to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. No deficiencies noted. An exit interview was conducted with Saudia King and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
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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