<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002995
Report Date: 04/19/2024
Date Signed: 04/19/2024 01:48:36 PM

Document Has Been Signed on 04/19/2024 01:48 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:PRESTIGE ENVIRONS FOR THE AGESFACILITY NUMBER:
315002995
ADMINISTRATOR/
DIRECTOR:
HEARD, TERESITAFACILITY TYPE:
740
ADDRESS:5350 NORTHCLIFF DRIVETELEPHONE:
(916) 625-1012
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 6CENSUS: 1DATE:
04/19/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Teresita Heard, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection. LPA met with Teresita Heard, Administrator, and explained purpose of inspection. The facility is licensed for (6) non-ambulatory residents, (1) resident may be bedridden, and has a hospice waiver approved for (6) residents. This location has been operating as a care home for many years. Currently, there is (1) resident in care and (0) residents under hospice. LPA observed staff Trey Heard, present and (1) resident to be resting in her room.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (2) resident bathrooms, kitchen, and laundry area. The Administrator and staff live in the facility. LPA observed the home to be clean, safe, odor free, in good repair and to not pose any health and safety risk or personal rights violation. Inside temperature was observed to be 76* F. Facility conducts quarterly fire drills and the smoke/monoxide alarms are in working order. The facility has a back yard area with covered seating and there is (1) unlocked exit gate. The grounds are well maintained and pest control regularly provides treatment. Hot water measured 105* F in the kitchen.

Each resident room has an exit door to the backyard. LPA observed toxins, sharps and medications to be locked in a separate areas. LPA observed sufficient 2+day perishable, including fresh produce, and 7+day non-perishable food. There are sufficient linens/towels and PPE on hand. LPA observed paper towels, soap, sanitizer in the bathrooms. LPA observed various Covid posters and required postings throughout.

LPA reviewed (1) resident file and found it to be organized and contain current documentation. Medications were organized and locked. Staff files are organized and also contain current documentation. Staff has current First Aid/CPR certification, and the Administrator has a medical background. All staff are cleared and associated. LPA observed the current Administrator certificate #6003786740- exp 7/7/25 to be posted. Infection Control Plan and Emergency Disaster Pans were reviewed. Copy of current liability insurance obtained along with current email address. There are no deficiencies cited. Exit interview. Report left.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1