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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920110
Report Date: 08/26/2024
Date Signed: 08/26/2024 01:53:23 PM

Document Has Been Signed on 08/26/2024 01:53 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:SAUNDERS HOME CAREFACILITY NUMBER:
315920110
ADMINISTRATOR/
DIRECTOR:		OSELSKY, RAISAFACILITY TYPE:
740
ADDRESS:5795 SAUNDERS AVENUETELEPHONE:
(916) 765-2952
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY: 6CENSUS: 0DATE:
08/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Raisa OselskyTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Monday August 26, 2024 to conduct an announced prelicensing visit.

The Compliance and Regulatory Enforcement Tool was used during today's inspection. This facility has a fire clearance for 6 nonambulatory residents, with a total capacity of 6. Facility has all required postings in the hallway.

LPA toured the facility with Administrator Raisa. The following areas were inspected for compliance: kitchen, backyard, resident rooms, bathrooms, staff room/office and common area. Facility has a current fire extinguisher and a full first aid kit. Medications will be kept locked in the hallway closet (between bedroom #2 and #3). Cleaning chemicals and knives/sharps will be kept locked and inaccessible to residents.

This facility had a fence surrounding the property with an electronic operated slide gate and gate code. Next to the gate, was a pedestrian gate which will be kept unlocked. Should the Licensee want to lock the pedestrian gate, a secured perimeter waiver will be requested from the Department.

Component III was waived due to the Licensee currently owning/operating another facility.

The facility appears to be in substantial compliance and ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. An exit interview was conducted with Administrator and a copy of this report will be left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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