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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585002656
Report Date: 04/04/2024
Date Signed: 04/04/2024 04:44:00 PM

Document Has Been Signed on 04/04/2024 04:44 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:CLAUDIA S. COOK HOME #2FACILITY NUMBER:
585002656
ADMINISTRATOR/
DIRECTOR:		COOK, JEAN-CLAUDEFACILITY TYPE:
735
ADDRESS:11536 JUDY STTELEPHONE:
(530) 763-1703
CITY:MARYSVILLESTATE: CAZIP CODE:
95901
CAPACITY: 4CENSUS: 4DATE:
04/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:Jean-Claude and Deshawn CookTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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LPA Hiratsuka conducted this unannounced case management in response to Community Care Licensing Division (CCLD) doing a file review update. There were a couple of questions about the staff schedule.

The owner of this facility has live-in staff. The staff also own a day program called All-Star Programs 297003934. The staff schedule submitted to CCLD for this facility shows an overlap with the staff from the day program. Licensee also owns Claudia S. Cook Home 297001009.

Today, LPA spoke with Administrator Jean-Claude Cook and Assistant Administrator Deshawn Cook.

The staff schedule is there are two people who live at this facility and both are employed by the day program. Licensee and her husband also work for the day program and the residential facilities and cover when the two main staff can't work. The clients who live at this facility don't always meet at the day program and will leave from this facility to somewhere in the community and are accompanied by a staff person.

LPA requested a new staff schedule for this facility and the day program with an explanation of how the hours work for each by Monday, April 8, 2024.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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