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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701333
Report Date: 08/29/2024
Date Signed: 08/29/2024 12:38:07 PM

Document Has Been Signed on 08/29/2024 12:38 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:COMMUNITY EXPERIENCE CENTER INCFACILITY NUMBER:
502701333
ADMINISTRATOR/
DIRECTOR:
KING, DEREKFACILITY TYPE:
775
ADDRESS:5933 STODDARD RD BUILDING 11TELEPHONE:
(209) 918-5482
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 100CENSUS: 12DATE:
08/29/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Saudia WhitakerTIME VISIT/
INSPECTION COMPLETED:
01:00 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 8/29/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a post licensing inspection. LPA Jensen met with Licensee Saudia Whitaker and explained the purpose of today's visit.

The exterior paths were clear. There are outdoor areas for client activities. The facility has a lobby with front desk for signing in. All signs were posted in prominent places. The facility currently has 12 clients and 6 staff were present on this day. All staff present had criminal background clearance and were associated. LPA Jensen toured the facility and observed it to be sanitary. The facility is well lit and furnished for a variety of activities. LPA observed some clients participating in a resume skills shop, some clients watching a movie in the theater on the big screen and other clients enjoying arts and crafts. One of the instructors at the facility is also a hair dresser and hair cuts are available for free in the facility salon for anyone who would like one. The facility has a large Emergency Response Board posted with clear directions on procedures and evacuations. The residents wear laminated name badges that indicate whether they have a special diet and any allergies. The fire extinguishers were last serviced on August 8, 2024 and in compliance. The smoke detectors are in the ducts. LPA Jensen tested the water temperature in one of the bathrooms and it measured at 120 degrees Fahrenheit which falls within the required range of 105-120 degrees. The men's urinals have disposable non-skid mats.

LPA Jensen inspected the kitchen and observed all food to be labeled. There was no expired food. The refrigerator temperature and freezer temperature was within the required range. LPA Jensen observed lunch service which included freshly prepared salmon burgers and a side plus dessert. 2 staff files were reviewed and 3 client files were reviewed. All files were complete and in compliance.

The inspection tool was used during the course of this inspection. The facility is in substantial compliance. No deficiencies were observed. An exit interview was conducted and a copy of this report was given.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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 1