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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507002067
Report Date: 11/23/2021
Date Signed: 11/23/2021 03:03:43 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/23/2021 03:03 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:
507002067
ADMINISTRATOR:BETHANY DUTTFACILITY TYPE:
735
ADDRESS:309 GAYLE AVENUETELEPHONE:
(209) 572-5050
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 6CENSUS: 4DATE:
11/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Bethany DuttTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Jason Lund conducted an unannounced annual required inspection and met with Administrator Bethany Dutt and explained the reason for the visit

LPA inspected the interior and exterior of the facility. The facility is found to be clean, safe, sanitary, and in good repair. There are no bodies of water present. Toxins and sharp tools are stored inaccessible to residents. LPA observed sufficient food supply. Fire extinguishers, smoke detectors, and carbon monoxide detectors are in compliance.

No deficiencies cited on today's visit.

Exit interview conducted with Administrator Bethany Dutt.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
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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