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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701020
Report Date: 06/23/2022
Date Signed: 06/23/2022 04:42:38 PM

Document Has Been Signed on 06/23/2022 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:HOPE'S CARE HOMEFACILITY NUMBER:
502701020
ADMINISTRATOR:SOLORIO, GLORIAFACILITY TYPE:
735
ADDRESS:315 LALOMA AVETELEPHONE:
(209) 505-1236
CITY:MODESTOSTATE: CAZIP CODE:
95354
CAPACITY: 6CENSUS: 5DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Administrator, Gloria SolorioTIME COMPLETED:
05:15 PM
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LPA Jason Lund arrived at above facility unannounced to conduct a annual/required visit. LPA Lund met with Daniel Solorio and later with Administrator, Gloria Solorio. LPA Lund explained the reason for the visit.
Census is five.

LPA Lund & Administrator Gloria Solorio toured the facility all (5) residents are Ambulatory only at this time. Kitchen area was toured. Cabinets and drawers were observed to be in good repair and contained all required dishes, cook ware, and flatware sufficient to meet the needs of the residents at this time. Cabinets storing knives and cleaning agents were observed to be locked and made inaccessible to the residents at this time. It was observed that there was a gate that latched separating the kitchen area from the common dining area.
Food storage units were reviewed and observed to be set at the proper temperatures for the refrigerator and freezer components.
Common areas were toured such as the living room, dining room, and all other areas intended for resident use. Furniture and furnishings were observed to be in good repair and able to meet the needs of the residents at this time.
A tour of the resident bedrooms was conducted. It was observed that resident bedrooms were furnished and maintained to meet the needs of the residents at this time.
Resident restrooms were toured. Linen closet was observed to contain all of the necessary components sufficient to meet the needs of the residents at this time. Fire extinguishers and carbon monoxide detectors were observed to have been annually purchased and in compliance at this time.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: HOPE'S CARE HOME
FACILITY NUMBER: 502701020
VISIT DATE: 06/23/2022
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Facility office area was toured. Resident files, staff files, and medications were observed to be maintained in compliance at this time. Medication cabinet was observed to be locked and made inaccessible to the residents at this time.
First aid kit was observed to be present and contained all necessary components at this time.
Laundry area was toured. It was observed that all cleaning agents, detergents, and supplies were locked and made inaccessible to the residents at this time.
A tour of the exterior grounds was conducted. A review of the perimeter fence, side gates, and exterior exits were conducted and observed to be in good repair at this time.

This facility has been observed to be in compliance at this time. No Deficiencies were ciliated at this time. Exit Interview Administrator, Gloria Solorio and report left.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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