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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701333
Report Date: 03/06/2025
Date Signed: 03/06/2025 09:35:37 PM

Document Has Been Signed on 03/06/2025 09:35 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: 29DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Director Saudia Whitaker TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a one year required inspection. LPA Lund met with Licensee Saudia Whitaker and explained the purpose of today's visit.

LPA Lund & Director Saudia Whitaker toured/inspected 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. LPA Lund observed the program to be clean and sanitary. The facility is well lit and furnished for a variety of activities. LPA observed some clients participating in various activities including, 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 hairdresser and haircuts 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 8/8/2024 and in compliance. The smoke detectors are in the ducts. The men's urinals have disposable non-skid mats. LPA Lund inspected the kitchen and observed all food to be labeled. There was no expired food. 2 staff files were reviewed, and 3 client files were reviewed. All files were complete and in compliance.

No deficiencies were observed. An exit interview was conducted, and a copy of this report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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