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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 09:48:42 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:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Ashlynn BurchTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Unannounced Plan of Correction 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.
The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 03/06/2024. This visit was to follow up on the Plans of Correction that were due.
The following deficiencies were observed and cited on 03/06/2024:
  • Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

  • The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) Tuberculosis test documents as specified in Section 80065(g).

  • Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.
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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  • All window screens shall be in good repair and be free of insects, dirt and other debris.

  • Each record must contain information including, but not limited to, the following:


This facility did complete the Plans of Correction and provided all of the required forms and documents at this time.
Plan of Correction clearance letters were printed and copies were provided to the facility staff person at this time.
There were no further deficiencies observed or cited during today's Plan of Correction 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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