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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700330
Report Date: 12/05/2024
Date Signed: 12/05/2024 03:02:11 PM

Document Has Been Signed on 12/05/2024 03:02 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PAULSON COMMUNITY- STANISLAUS HOME, THEFACILITY NUMBER:
502700330
ADMINISTRATOR/
DIRECTOR:
HEKIMIAN, ARENFACILITY TYPE:
735
ADDRESS:2800 PAULSON RDTELEPHONE:
(559) 705-6997
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: 5CENSUS: 4DATE:
12/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Jessica VillasenorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing program Analyst (LPA) Renee Campbell conducted an unannounced annual required visit at the above Facility on 12/05/2024. LPA Campbell met with Team Lead, Jessica Villasenor and toured the facility inside and outside. Residents of the facility were on an outing in the community per the Team Lead.

The facility is licensed to serve developmentally disabled adults ages 18 to 59 and approved for delayed egress. The facility has 1 common area, Staff office, a staff bathroom and 5 resident rooms with a bathroom in each. There is a meeting area, dining area, computer area and a laundry area. There are client bathrooms with grab bars, paper towels and soap. There are cameras on the outside of the building.

The Facility has a kitchen area with a sink, refrigerator and food pantry. Locked sharps drawers were observed in the kitchen area. LPA Campbell observed enough perishables to last two days and enough non-perishables to last 7 days. Dining plates and utensils were observed in the kitchen cabinets. The refrigerator temperature was 37 degrees Fahrenheit and the freezer temperature was 0 degrees Fahrenheit. The hot water in the kitchen was measured at 108 degrees Fahrenheit. The hot water in the resident’s bathroom was measured at 106 degrees Fahrenheit. The medications will be locked in the Staff office. There is a delayed egress on the front door and side gate from the backyard and exterior gate in the common area of the facility. Cleaning products were observed locked away in a closet.

Of the 30 staff working at the facility, 4 files were reviewed. All 4 staff were found to be fingerprint cleared and associated to the facility and their files complete. There were 4 client files that were reviewed as well. Exit interview held with the Team Lead and a copy of report was given at the conclusion of the visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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