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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920036
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:48:33 PM

Document Has Been Signed on 10/23/2024 02:48 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:ASPEN MEADOWS CARE HOME BY RNSFACILITY NUMBER:
315920036
ADMINISTRATOR/
DIRECTOR:		PATAWARAN, YASSERFACILITY TYPE:
740
ADDRESS:531 ASPEN MEADOWS WAYTELEPHONE:
(916) 409-5620
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 6CENSUS: 2DATE:
10/23/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Daniel GalangTIME VISIT/
INSPECTION COMPLETED:
03:00 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 Analysts (LPA) Graham Gunby and Cheyenne Ratajczak arrived unannounced to conduct a post-licensing inspection. LPAs met with caregiver, Daniel Galang and explained the purpose of the visit. LPAs requested for staff to notify Administrator, Yasser Patawaran of LPA's presence at the facility. Administrator was unable to meet at the facility and gave staff permission to assist LPA during today's visit.

LPAs and staff conducted a tour of the interior of the facility and inspected the physical plant, kitchen, bedrooms, bathrooms, laundry area, and backyard area. LPA observed the facility to be free of odor, clean and in good repair. There is sufficient furniture and lighting throughout the facility. LPA observed required 7 day non-perishable and 2 day perishable food. LPA observed locked medications, knives and toxins to be inaccessible to residents. LPA observed two (2) resident files and two (2) staff files to be organized and complete.

LPA observed all required documents to be posted in entry.

Exit interview conducted. No deficiencies cited at this time.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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