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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700703
Report Date: 12/03/2024
Date Signed: 12/03/2024 04:42:32 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/03/2024 04:42 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- YOSEMITE HOME, THEFACILITY NUMBER:
502700703
ADMINISTRATOR/
DIRECTOR:
HEKIMIAN, ARENFACILITY TYPE:
735
ADDRESS:2804 PAULSON RDTELEPHONE:
(559) 228-3056
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: 5CENSUS: DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Jessica Villasenor, Team LeaTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing program Analyst (LPA) Renee Campbell conducted an unannounced annual required visit at the above Facility. 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 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 dishwasher and food pantry. LPA Campbell observed enough perishables to last two days and enough non-perishables to last 7 days. The refrigerator temperature was 37 degrees Fahrenheit and the freezer temperature was 0 degrees Fahrenheit. The hot water in the kitchen was measured at 106 degrees Fahrenheit. The hot water in the resident’s bathroom was measured at 105.8 degrees Fahrenheit. The medications will be locked in the Staff office. There is a delayed egress on the front door, side gate from the backyard and exterior gate in the common area of the facility.

There are designated cabinets for client’s belongings outside of each room. Locked file cabinets are located in the staff office for files. A facility sketch was observed on the wall. Fire extinguishers were last inspected on 12/06/2024 and smoke detectors are current and in compliance with fire safety. Of the 30 staff who work in the facility, 4 files were viewed and found to be complete. All staff had been fingerprint cleared and were associated to the facility. Of the 4 clients for the facility, all 4 of their files were reviewed and found to be complete.

Exit interview held with the Administrator and a copy of report given at the conclusion of the visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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