<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701020
Report Date: 06/18/2024
Date Signed: 06/18/2024 05:06:58 PM

Document Has Been Signed on 06/18/2024 05:06 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:HOPE'S CARE HOMEFACILITY NUMBER:
502701020
ADMINISTRATOR/
DIRECTOR:
SOLORIO, GLORIAFACILITY TYPE:
735
ADDRESS:315 LALOMA AVETELEPHONE:
(209) 505-1236
CITY:MODESTOSTATE: CAZIP CODE:
95354
CAPACITY: 6CENSUS: 5DATE:
06/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Gloria Solorio, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 06/18/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to conduct an annual inspection. Upon entry, LPA Campbell observed one resident in the living room and two resident outside sitting in the backyard. Direct Support Provider (DSP) Vanessa Solorio greeted LPA Campbell and a tour of the facility was conducted.

After allowing LPA Campbell to use the facility office, DSP Solorio took LPA Campbell to the backyard. The South exit was obstructed with metal debris, a pile of leaves and a full bin of foliage. The yard itself was overgrown but had a seating area with chairs, a game area for a ping pong table, horseshoes and boxing. Two bikes were observed on the patio. The North side exit of the facility had overgrown grass. a water hose lay across the path and another bin sat directly in front of the gate exit. During the inspection, licensee cleared both sides to allow an unobstructed access to the front yard. A Technical Violation was issued.

The living room contained a sofa and television along with accessories. There were two refrigerators in the kitchen and there were enough perishables to last the facility 3 days. One appliance temperature was measured at 8 degrees Fahrenheit for the freezer and 42 degrees for the refrigerator. The other appliance was measured at 4 degrees Fahrenheit for the freezer ad 39 degrees Fahrenheit. Both measurements were within compliance. Knives were locked up and inaccessible to residents in the kitchen drawer. Cleaning supplies were also locked in a closet across from the kichen. A fully charged fire extinguisher was observed in the kitchen. LPA could not find proof of inspection but the extinguisher was fully charged. A Technical Violation was issued and the receipt will be taped to the extinguisher to confirm purchase date.

One staff file of 7 staff and 1 client file of 5 clients were reviewed. Employee rights and health screening were missing from the staff file and no dates were listed on the employee job application. Per licensee, the health screening had been received but was missing. The licensee will review client and staff files to ensure they are complete and all dates are entered.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HOPE'S CARE HOME
FACILITY NUMBER: 502701020
VISIT DATE: 06/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on observation, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. An exit interview was conducted and a copy of this report was given to the facility.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2