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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701231
Report Date: 01/10/2024
Date Signed: 01/10/2024 12:43:39 PM

Document Has Been Signed on 01/10/2024 12:43 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:SHELTERING ARMS LLCFACILITY NUMBER:
502701231
ADMINISTRATOR:DHILLON, JATINDERFACILITY TYPE:
735
ADDRESS:3401 PUMA WAYTELEPHONE:
(209) 535-7588
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY: 4CENSUS: 1DATE:
01/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Davinderbir Dhillon, Direct Service ProviderTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct an annual inspection. LPA Campbell met with Davinderbir Dhillon, Direct Service Provider and explained the purpose of the visit.

As observed by LPA Campbell, there is only one client residing in the facility. Their client files indicate that the resident is able to ambulate without assistance and is capable of seeing to his own cash resources.

LPA Campbell toured the facility and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas to ensure there are no safety hazards for residents. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 71 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 107 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. The backyard was toured by LPA Campbell and pathways and exits were found to be without obstacles.

LPA Campbell observed first aid supplies, a fully charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPA Campbell observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Campbell observed locked closets and cabinets for the storage of medication. LPA Campbell observed locked storage areas for the storage of cleaning solutions and knives as well.

LPA Campbell interviewed three staff members which included the licensee and two Direct Service Providers (DSP) as required for the CARE Tool. Files for two staff members and one resident was also reviewed.

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, no deficiencies are being cited.
An exit interview was conducted with Davinderbir Dhillon, Direct Service Provider and a copy of this report was provided. 
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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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