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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700016
Report Date: 07/29/2024
Date Signed: 07/29/2024 04:13:58 PM

Document Has Been Signed on 07/29/2024 04:13 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:RESTPADD CARE LLCFACILITY NUMBER:
342700016
ADMINISTRATOR/
DIRECTOR:
NWANGBURUKA, IHEOMAFACILITY TYPE:
740
ADDRESS:6901 RIO TEJO WAYTELEPHONE:
(916) 685-3690
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 6CENSUS: 5DATE:
07/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Iheoma NwangburukaTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a case management visit to follow up on incidents reports submitted to the Regional Office. LPA Valerio met with Administrator Iheoma Nwangburuka, and explained the purpose of the visit.

Two incident reports were submitted, one dated 07/09/2024 and the other dated 07/10/2024. Both incident reports had information that relayed medical emergencies and change of condition; however, the boxes for alleged client abuse were checked.

LPA Valerio discussed follow up care for both resident incidents. LPA Valerio advised Administrator Iheoma to review the report prior to submission to ensure the type of incident box is marked correctly.

No deficiencies were cited

An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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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