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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920037
Report Date: 10/30/2024
Date Signed: 11/08/2024 04:59:54 PM

Document Has Been Signed on 11/08/2024 04:59 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:SAPPHIRE SENIOR CAREFACILITY NUMBER:
315920037
ADMINISTRATOR/
DIRECTOR:		TULENINOVA, NATALIAFACILITY TYPE:
740
ADDRESS:667 GRIDER DRIVETELEPHONE:
(916) 257-4525
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 5DATE:
10/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Natalia TuleninovaTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 10/30/24 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit. Administrator was present to assist with the visit.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed.

Staff and resident files were reviewed. LPA advised on a few topics that are not violations.
LPA and administrator discussed the exception process were they to consider care for a resident where a exception is needed.

Licensee is in process of a room renovation. LPA will be notified when it is completed.

No deficiencies are being cited as a result of todays inspection.


Exit interview conducted and copy of report left at the facility
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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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