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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
515002676
Report Date:
08/01/2024
Date Signed:
08/01/2024 02:53:20 PM
Document Has Been Signed on
08/01/2024 02:53 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 NORTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
RHEA DODD CARE HOME #2
FACILITY NUMBER:
515002676
ADMINISTRATOR/
DIRECTOR:
DODD, RHEA
FACILITY TYPE:
735
ADDRESS:
636 TULSA DRIVE
TELEPHONE:
(916) 955-5163
CITY:
YUBA CITY
STATE:
CA
ZIP CODE:
95991
CAPACITY:
4
CENSUS:
4
DATE:
08/01/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:
Rhea Dodd
TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Hiratsuka and (LPA) Gunby conducted this unannounced required annual visit. LPAs toured the facility with administrator Rhea Dodd.
This facility has four private resident rooms and one staff room. There is one full common bathroom and one resident room has a full private bathroom. The main entrance opens into a common area and there is a second common area and kitchen in the back of the facility. There is an ample supply of perishable and non-perishable food. There were no health and safety issues observed during the tour.
Two of four resident files were reviewed and three staff files were reviewed.
Several topics were discussed.
No deficiencies cited.
SUPERVISORS NAME
:
Troy Ordonez
LICENSING EVALUATOR NAME
:
Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/01/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/01/2024
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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