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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507004954
Report Date: 12/03/2024
Date Signed: 12/03/2024 12:47:01 PM

Document Has Been Signed on 12/03/2024 12:47 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:DAVIS GUEST HOME VII/VILLAFACILITY NUMBER:
507004954
ADMINISTRATOR/
DIRECTOR:		JESSICA SANCHEZFACILITY TYPE:
735
ADDRESS:1232 NADINE AVE.TELEPHONE:
(209) 554-5220
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 24CENSUS: 24DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Heather McClosky, House ManagerTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct an annual inspection. LPA Campbell met with Heather McClosky, House Manager and  explained the purpose of the visit.

The facility is a one story building licensed to serve 20 ambulatory and 4 non-ambulatory mentally disabled adults between the ages of 18 and 69. As reported by the House Manager, there are 24 clients currently residing in the facility.  No body of water was observed on the premises.

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. Furniture and accessory furnishings were sufficient to meet the needs of residents. The facility temperature was 72 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's hot water temperature in the bathroom was measured at 120 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. The hot water temperature in the kitchen was recorded as 130 degrees Fahrenheit and was accompanied by a Hot Water Warning sign. The yard was toured by LPA Campbell and pathways and exits were found to be clear.

LPA Campbell observed first aid supplies, a fully-charged and up-to-date fire extinguisher last inspected on 08/01/2024, and working carbon monoxide/smoke detectors.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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 VII/VILLA
FACILITY NUMBER: 507004954
VISIT DATE: 12/03/2024
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LPA Campbell observed a minimum 2-day supply of perishable food in the refrigerator and a minimum 7-day supply of nonperishable food in two pantries. LPA Campbell observed two locked closets and cabinets for the storage of medication. LPA Campbell observed locked storage areas for the storage of cleaning solutions in the linen closet.

LPA Campbell interviewed two staff members which included the House Manager and Administrator as required for the CARE Tool.

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, no deficiencies are being cited. An exit interview was conducted with Heather McClosky, House Manager and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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