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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 557001183
Report Date: 11/07/2024
Date Signed: 11/20/2024 12:45:55 PM

Document Has Been Signed on 11/20/2024 12:45 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:VALLEY OAKS FAMILY HOMEFACILITY NUMBER:
557001183
ADMINISTRATOR/
DIRECTOR:		MONA B. GASKILLFACILITY TYPE:
735
ADDRESS:16649 ANDERSON ROADTELEPHONE:
(209) 928-1196
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: 8CENSUS: 7DATE:
11/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 11/7/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required one year annual visit. LPA Jensen met Mario Hernandez Espinosa and Licensee Mona Gaskill and explained the purpose of today's visit.

LPA Jensen toured the grounds and observed ample shaded areas and patio furniture for client engagement in outdoor activities. LPA Jensen toured the interior and observed adequate furnishings and lighting throughout. A pellet burning stove, which was serviced last week, provides heat in cooler temperatures. The interior was 68 degrees which falls within the required range. LPA Jensen tested the water temperature at the lower level sink and found it to be within the required range. Night lights in hall ways are available. The smoke detector and carbon monoxide detector were tested and determined to be on good working order. The first aid kit is complete and in compliance. The facility conduct annual fire drills.

The kitchen was toured. A 2 day supply of perishable food and 7 day supply of non-perishable food is available including fresh fruit vegetables and various snacks. LPA Jensen observed lunch service which consisted of a sandwich and chips or a client choice substitution. LPA Jensen toured the client bedrooms and observed adequate furnishings in all rooms. The bedrooms are double occupancy and there are currently 7 clients. An adequate supply of linens was observed.

LPA Jensen reviewed 4 resident files and 3 staff files. LPA Jensen advised the Licensee that updated Individual Program Plans should be requested from the Regional Center. The staff files were observed to be complete and compliant. LPA Jensen interviewed the 3 clients that were present during the course of this visit and all clients stated they are satisfied with their home environment. Daily outings are provided.
The facility is in substantial compliance. Technical assistance is being provided. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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