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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570317743
Report Date: 05/30/2023
Date Signed: 05/30/2023 04:42:28 PM

Document Has Been Signed on 05/30/2023 04:42 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:DAVIS SUMMER HOUSEFACILITY NUMBER:
570317743
ADMINISTRATOR:JULIE HUNTERFACILITY TYPE:
735
ADDRESS:2525 EAST 8TH STREETTELEPHONE:
(530) 757-1294
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 14CENSUS: 12DATE:
05/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Michael Yuen-Hurwitz, Program Manager and TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Required inspection and met with Michael Yuen-Hurwitz, Program Manager and Gloria Lane-Ricafrente, Assistant Program Manager . There are currently 12 residents at this Adult Residential Facility.

Upon arrival, LPA observed hand sanitizer, a thermometer, and a box of surgical masks at the entrance to the facility. LPA conducted a walk-through of the facility and found it to be clean, well-organized and a comfortable temperature between 72-74 F. There were 8 carbon monoxide detectors which were tested and operational. There were 4 fire extinguishers which were fully charged and last serviced on 4/16/2023. The facility had Emergency Fire Drills on 5/21/23 and 5/22/23. All staff have had First Aid/CPR training. The med room is locked and medications are double-checked prior to being administered. The kitchen was well-stocked and sharps are locked when not in use.

LPA observed residents returning from participating in Day programs. They were excited to share their experiences of the day with one another. There was a real sense of community, with residents participating in meal prep and planning, recreational activities, and enjoying social time together.

Exit interview conducted with Gloria Lane-Ricafrente, Assistant Program Manager, whose signature on this document confirms receipt.



No deficiencies cited during this inspection
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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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