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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002841
Report Date: 02/03/2025
Date Signed: 02/03/2025 01:17:31 PM

Document Has Been Signed on 02/03/2025 01:17 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:AUBURN VALLEY SENIOR LIVINGFACILITY NUMBER:
315002841
ADMINISTRATOR/
DIRECTOR:
DOCMANOV, ANAMARIAFACILITY TYPE:
740
ADDRESS:3800 LORAY LANETELEPHONE:
(916) 757-7057
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY: 6CENSUS: 5DATE:
02/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Magdalena Szanto, CaregiverTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 2/3/2025 LPA Tryon visited the home to do an annual visit. LPA met with Staff Magdalena Szanto

LPA toured the facility including common areas, kitchen, food supplies, laundry, medication area, bedrooms, bathrooms, hallways. The facility is clean, in good condition and well-furnished.

Food supplies are adequate to meet the requirement of 2 days perishable and 7 days non-perishable. The facility has a good supply of PPE, hand sanitizer, soaps, paper products ,etc.

Appropriate postings, posters such as client's rights, reporting agencies, emergency plans, etc. are present.

LPA reviewed 2 of 5 resident files and 2 files for staff. Files appear complete and accurate.

LPA reviewed the CARE Tool with staff.

LPA spoke with two staff during the visit. Residents were resting after lunch so LPA did not disturb them for interviews.

LPA requested copy of current Liability policy.

At this time, the facility appears to be in substantial compliance with the regulations. No deficiencies were cited at this visit.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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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