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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700864
Report Date: 09/29/2022
Date Signed: 10/04/2022 10:12:08 AM

Document Has Been Signed on 10/04/2022 10:12 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SHELTERING ARMS LLCFACILITY NUMBER:
502700864
ADMINISTRATOR:DHILLO, JATINDERFACILITY TYPE:
735
ADDRESS:1112 TWILIGHT DRIVETELEPHONE:
(209) 535-7588
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY: 4CENSUS: 4DATE:
09/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jatinder DhilloTIME COMPLETED:
12:30 PM
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Unannounced annual visit made out to this facility on 09/29/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility personnel, Jaideep Singh and Amanda Knowles, who were requested by this LPA to go ahead and contact the facility designated Administrator, Jatinder Dhillo, who arrived shortly thereafter to this facility. Brief interview was conducted with the facility designated Administrator. It was learned that this facility was vendorized through Valley Mountain Regional Center to accept and retain up to (4) Level 4I residents.
Staff ratios were maintained to make sure that residents were receiving adequate care and supervision at this time.
Current census was 4 residents.
A tour of this facility was conducted alongside the facility designated Administrator Jatinder Dhillo.
Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Jatinder Dhillo.
Kitchen area was toured. Cabinets and drawers were reviewed.
Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time in the garage area.
A tour of the dining area, living area, and all other areas intended for resident use was conducted.
Medication cabinet, located in the facility office room, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications was discussed with the facility designated Administrator. This medication cabinet was observed to be locked and made inaccessible to the residents at this time.
A tour of the resident bedrooms and restroom was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.
Hot water temperature was taken and measured to make sure that it was within the allowed range of 105-120 degrees. Grab bars and non skid mats were observed to be present and in good repair at this time.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SHELTERING ARMS LLC
FACILITY NUMBER: 502700864
VISIT DATE: 09/29/2022
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Linen closet, located in the facility hallway, was observed to contain a sufficient supply of towels, blankets, and linens sufficient to meet the needs of the residents at this time.
Exterior patio area was toured. This area was used by the residents to utilize when the weather permitted.
First aid kit was observed to be present and contained all of the necessary components at this time.
Laundry area was toured in the garage. Cabinets storing detergents and bleach were observed to be locked and made inaccessible to the residents at this time.
Fire extinguisher, located in the kitchen area, was observed to have been annually purchased by the facility designated Administrator with proof of purchase date, 07/19/2022, from the Home Depot attached to the fire extinguisher at this time.
Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gate, and exits was conducted.

The following forms and documents were requested to be updated and submitted into CCL:
  • LIC 308

  • LIC 400

  • LIC 500

  • LIC 610


There were no deficiencies observed or cited during todays annual visit.

Exit Interview
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC809 (FAS) - (06/04)
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