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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507001468
Report Date: 12/23/2022
Date Signed: 12/23/2022 12:07:49 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/23/2022 12:07 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SIERRA SALEM CHRISTIAN HOMES INC.FACILITY NUMBER:
507001468
ADMINISTRATOR:DEBORAH MENSONIDESFACILITY TYPE:
735
ADDRESS:1805 WOODLAND AVENUETELEPHONE:
(209) 544-9300
CITY:MODESTOSTATE: CAZIP CODE:
95358
CAPACITY: 6CENSUS: 6DATE:
12/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator Deborah MensonidesTIME COMPLETED:
12:30 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
Licensing Program Analyst (LPA) Jason Lund made an unannounced visit to conduct an abbreviated annual inspection. LPA Lund met with Administrator Deborah Mensonides and explained the reason for the visit. An annual inspection was previously conducted on 12/12/2022 by LPA Charlie Yang. LPA Lund met with Administrator Deborah Mensonides, observed the following
· Covid precautions being followed
· Interior and exterior of the plant
· (7) seven day non-perishable and (2) day perishable supply of food
· Medications were observed to be locked up
· Fire extinguisher fully charged.
· Smoke detectors all operational.
· Hot water temperature measured 102 degrees.
· All employees requiring background checks are cleared.

There are no Health and Safety concerns at this time. Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was left with Administrator Deborah Mensonides.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2022
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