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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515002718
Report Date: 06/19/2023
Date Signed: 06/22/2023 12:35:17 PM

Document Has Been Signed on 06/22/2023 12:35 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:RHEA DODD CARE HOMEFACILITY NUMBER:
515002718
ADMINISTRATOR:DODD, RHEAFACILITY TYPE:
735
ADDRESS:1174 NORMANDY CTTELEPHONE:
(916) 955-5163
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY: 4CENSUS: 3DATE:
06/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Rhea DoddTIME COMPLETED:
12:45 PM
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On 6/22/2023 LPA Tryon visited the facility to complete an annual inspection. LPA met with licensee Rhea Dodd. The home currently has 3 residents.
LPA toured the facility with licensee including common areas, kitchen, bedrooms, bathrooms, laundry, hallways, storage, yard/patio, The home is clean and in good condition,nicely furnished and supplied.
Food supplies are more than adequate to meet the requirement of 2 days perishable and 7 days non-perishable. Refrigerator/freezer are at appropriate temperature. Bedrooms are nicely and appropriately furnished as per regulation. Smoke detectors and carbon monoxide detector installed, along with fire alarm system. Fire extinguishers present and charged.
LPA reviewed the CARE Tool with Mrs. Dodd. LPA reviewed staff and resident files. Proof of appropriate staff training and criminal record clearance present, Administrator Certificate, physical report, etc. Client files include signed Admission Agreements, updated physician reports, current IPPs, ID sheets with contact information, etc.
Emergency/disaster plans reviewed as well as Infection plan/practices.

At this time the home appears to be in substantial compliance with regulations.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2023
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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