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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500332206
Report Date: 03/03/2025
Date Signed: 03/04/2025 09:48:17 AM

Document Has Been Signed on 03/04/2025 09:48 AM - 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:DEL RIO GUEST HOMEFACILITY NUMBER:
500332206
ADMINISTRATOR/
DIRECTOR:		ASHLYNN BURCHFACILITY TYPE:
735
ADDRESS:2841 PATTERSON RDTELEPHONE:
(209) 869-2420
CITY:RIVERBANKSTATE: CAZIP CODE:
95367
CAPACITY: 15CENSUS: 9DATE:
03/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Ashlynn BurchTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Unannounced annual visit made out to this facility on 03/03/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Pamela Hightower, who was briefly interviewed at this time.
This LPA requested that she go ahead and contact the facility designated Administrator, Ashlynn Burch, to inform her that CCL was present at this time. The facility designated Administrator arrived later to this facility while this LPA was conducting this annual visit.
Current census was (9) residents, of which, (8) residents were out of the facility at this time attending their respective day programs.
It was learned that this facility was vendorized through Valley Mountain Regional Center (VMRC) to be able to accept and retain Level 2 residents at any given time.
Tour of the facility was conducted.
Kitchen area was toured. Cabinets and drawers were reviewed to make sure that this facility had a sufficient supply of plates, dinnerware, and flatware in order to be able to meet the needs of the residents at this time.
Food storage units were observed to be present and in functional order at this time.
A review of the 2-day perishable and 7-day non-perishable food quantities was conducted and observed to be in compliance at this time.
Additional food storage units were observed to be present in other areas of this facility and found to be in compliance at this time.
Medication cabinets, located in the facility entry/laundry area, was toured. Medications were observed to be stored and made inaccessible to the residents at this time. A review of the facility Medication Administration Record was conducted at this time.
First aid kit was observed to be present and did contain all of the required components at this time.
Laundry area was toured. Cabinets housing detergents, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.
Fire extinguishers, located throughout this facility, were observed to have been recently checked by the local fire extinguisher company, Jorgensen Co, on 01/24/2025 and in compliance at this time.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
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: DEL RIO GUEST HOME
FACILITY NUMBER: 500332206
VISIT DATE: 03/03/2025
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A tour of the dining area, living area, and all other areas designated for resident use were observed to be furnished and maintained in compliance at this time.
A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time in compliance.
A tour of the resident restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the resident at this time in compliance.
Hot water temperatures were taken to make sure that the hot water being dispensed for resident use were within the allowed range of 105-120 degrees at all times.
Administrator Certificate for the facility designated Administrator, Ashlynn Burch, was observed to have the following certificate number #6065824735 set to expire on 01/29/2025 at this time. It was learned that forms and documents have been submitted to properly update and renew this Administrator certificate back on 01/02/2025.
A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gate, and all other exits was conducted at this time.
A review of the walkways surrounding this facility was conducted.
A review of (5) facility staff files was conducted and noted on the following LIC 859.
A review of (5) facility resident files was conducted and noted on the following LIC 858.

The following forms and documents were requested to be updated and submitted into CCL for review by this LPA:

LIC 308
LIC 400
LIC 500
LIC 610

There were no deficiencies observed or cited during today's annual visit.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC809 (FAS) - (06/04)
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