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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500332307
Report Date: 09/25/2024
Date Signed: 09/27/2024 11:39:40 AM

Document Has Been Signed on 09/27/2024 11:39 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:DAVIS GUEST HOME #2FACILITY NUMBER:
500332307
ADMINISTRATOR/
DIRECTOR:		VALERIA OROZCOFACILITY TYPE:
735
ADDRESS:1900 EAST HATCH ROADTELEPHONE:
(209) 538-1496
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 49CENSUS: 46DATE:
09/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Misty Speegel, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct an annual inspection. LPA Campbell met with Misty Speegel, Administrator and Chris Hernandez, House Manager and explained the purpose of the visit. Residents were observed throughout the facility sitting quietly, retrieving medication, and requesting snacks from staff. The facility was clear of debris and passages were unobstructed. LPA Campbell toured the facility and inspected common areas, the kitchen, bedrooms and bathrooms, 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. All bedrooms are designed to be shared with two residents.

Of the 40 staff files available, LPA Campbell was able to review 4 staff files and found them to be complete. All active staff were found to be cleared in Guardian as well. LPA Campbell reviewed the certificate for Administrator Misty Speegle that expires on 11/20/25. No request to update the facilities profile with a new administrator was found. The facility will resubmit the request, required documents and a copy of the original administrator change request that was sent in August of 2024 by 09/30/2024

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 -5 degrees Fahrenheit. Refrigerator temperatures are to be no higher than 45 degrees Fahrenheit. Of the one
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
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: DAVIS GUEST HOME #2
FACILITY NUMBER: 500332307
VISIT DATE: 09/25/2024
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refrigerator 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 120 degrees Fahrenheit. The facility temperature was 74 degrees Fahrenheit, which is within the required range of 68 and 85 degrees.

LPA Campbell observed first aid supplies, a fully-charged and up-to-date fire extinguisher that was last checked on 09/02/2024 and a working combination carbon monoxide/smoke detector that was 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 medcarts for the storage of client medications. LPA Campbell also observed locked storage areas for cleaning solutions in the laundry room.

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, no deficiencies are being cited.


An exit interview was conducted with Misty Speegle and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
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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