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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507001184
Report Date: 01/31/2025
Date Signed: 01/31/2025 11:02:32 AM

Document Has Been Signed on 01/31/2025 11:02 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:DAVIS GUEST HOME #5FACILITY NUMBER:
507001184
ADMINISTRATOR/
DIRECTOR:		HEATHER MCCLOSKYFACILITY TYPE:
740
ADDRESS:2405 MAUNA LOA DRIVETELEPHONE:
(209) 556-9204
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
01/31/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Heather McClosky, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct an annual inspection. LPA Campbell met with Heather McClosky, Administrator  and explained the purpose of the visit.

As observed by LPA Campbell, there are seven residents currently in the facility. The facility is a single story building with four bedrooms and two bathrooms. It is licensed to serve 6 ambulatory residents and 2 non-ambulatory residents in the northwest bedroom only. The facilities receive referrals state-wide and are not currently contracted with Valley Mountain Regional or Central Valley Regional.

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. Wheelchair ramps were observed at the front and back entrances. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 75 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 112 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 clear.
Lisa RiosTELEPHONE: (916) 969-9685
Renee CampbellTELEPHONE: (916) 206-6380
DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DAVIS GUEST HOME #5
FACILITY NUMBER: 507001184
VISIT DATE: 01/31/2025
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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.

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 8, no deficiencies are being cited.
An exit interview was conducted with Heather McClosky and a copy of this report was provided.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC809 (FAS) - (06/04)
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