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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701231
Report Date: 01/10/2025
Date Signed: 01/10/2025 11:54:25 AM

Document Has Been Signed on 01/10/2025 11:54 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SHELTERING ARMS LLCFACILITY NUMBER:
502701231
ADMINISTRATOR/
DIRECTOR:
DHILLON, JATINDERFACILITY TYPE:
735
ADDRESS:3401 PUMA WAYTELEPHONE:
(209) 920-4494
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY: 4CENSUS: 3DATE:
01/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Simrat Padda, Direct Service ProviderTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 01/10/2024, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility unannounced regarding an annual inspection. LPA Campbell met with Direct Service Provider (DSP) Simrat Padda who is verified as fingerprint cleared and explained the purpose of the visit.

Upon entry, LPA Campbell observed a guest sign in sheet, a bedroom entry and the door to the office. DSP Simrat Padda provided a table where LPA Campbell worked to complete the inspection. DSP Padda stated that R2 and R3 were in the facility, and R1 was at day program. In full, three clients reside in the facility. Duriing the visit, R2 took a shower, and R3 got up for the day to prepare to go to day program. R2 also exhibited behaviors during inspection and DSP Padded redirected them successfully..

The facility is a single-story building with four bedrooms and two bathrooms. It is licensed to serve 18 to 59 year old ambulatory clients. There is a master bedroom connected to the master bedroom. One bathroom is in the hallway for the rest of the clients and guests. A laundry room is off the dining room. On the other side of the laundry room is the garage. LPA Campbell observed appropriate furniture in the living room, bedroom and dining room.

Water temperature was measured in the bathroom at 113.11 degrees Fahrenheit (F). The facility temperature was measured at 72 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The refrigerator was set at 43 degrees F, which is the maximum temperature required. The freezer temperature was 0 degrees F. The backyard is clear of debris with an unobstructed pathway to the fire exit. There is a shaded seating area and a gated space for a garden. The fire extinguisher is full and in good condition. Smoke alarms are functioning.

Of the 7 staff members working at the facility, LPA Campbell reviewed 3 files. Of the 3 clients in the facility, 3 of the files were 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 and a copy of this report was provided.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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