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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701330
Report Date: 07/18/2024
Date Signed: 07/18/2024 01:59:53 PM

Document Has Been Signed on 07/18/2024 01:59 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 HOME #2FACILITY NUMBER:
502701330
ADMINISTRATOR/
DIRECTOR:		SOLORIO, GLORIAFACILITY TYPE:
735
ADDRESS:1800 RIVER RDTELEPHONE:
(209) 505-1236
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 6CENSUS: 6DATE:
07/18/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Gloria Solorio, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On 07/18/2024, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to the facility and met with Administrator Gloria Solorio. LPA Renee Campbell explained the purpose of the Post-Licensing visit. Upon entry, LPA Campbell observed several residents in the hallway or watching TV.

Upon request, LPA Campbell was provided the files for residents and staff. Of the 6 resident files, 5 were reviewed. Of the 9 staff capable of working at the facility, 6 of the files were reviewed. During the inspection, staff needed to search for documents to ensure all files were complete for staff and residents. LPA Campbell advised administrator on how documents and files can be arranged for easy access. Centrally stored medication was observed as staff provided medication to a resident. The Medication Administration Records were reviewed and compared to the medication on hand for residents. LPA Campbell reviewed the medication logs for 2 of 6 residents randomly selected and found them to be complete..

When LPA Campbell attempted to review the staff associated to the facility,no staff were listed other than the administrator. Existing staff had not been transferred to this facility. Administrator will fill out form 9182 to transfer staff as of 07/19/24 so that staff can be associated to facility.

This facility is hereby cited per 22 CCR Section 87355(e)(1) and a civil penalty assessed. An exit interview was held with Administrator Gloria Solorio. Appeal rights and a copy of this report were left with the facility..



SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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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Document Has Been Signed on 07/18/2024 01:59 PM - It Cannot Be Edited


Created By: Renee Campbell On 07/18/2024 at 01:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HOPE'S CARE HOME #2
FACILITY NUMBER: 502701330

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
07/19/2024
Section Cited
CCR
87355(e)(1)

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87355(e)(1) Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement is not met as evidenced by:
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The Administrator has agreed to get staff associated immediately. Administrator will provide form LIC 9182 for each staff that works in the facility within 24 hrs and pay a civil penalty upon receipt of the invoice..
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Based on Licensing Information System (LIS) reviewed. Staff are not currently associated to the facility. This posed an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Renee Campbell
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2024


LIC809 (FAS) - (06/04)
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