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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700157
Report Date: 06/13/2023
Date Signed: 06/13/2023 12:14:34 PM

Document Has Been Signed on 06/13/2023 12:14 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:CHALET, THEFACILITY NUMBER:
342700157
ADMINISTRATOR:PATEL, NISHAFACILITY TYPE:
740
ADDRESS:6487 MAIN STREETTELEPHONE:
(925) 787-2740
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 41CENSUS: 23DATE:
06/13/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nisha and Knual PatelTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Manager (LPM) Laura Munoz and Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday June 13, 2023 to conduct an announced case management visit. This was a joint visit with Jenae Smith and Flor Olivares from Sacramento Metro Fire.

The facility was inspected on 3/19/2020 and granted an increase in their non-ambulatory clearance. Per the STD 850, the facility was granted non-ambulatory clearance for 41 residents with no restrictions. However, based on a recent annual fire inspection, the Fire Inspector noted that the previous fire clearance was in error as there is only one enclosed stairwell at the facility. During today's inspection, there are 12 residents residing on the second floor of which 5 are non-ambulatory. The facility is currently in compliance with the fire code. Per current fire code regulations, the facility can only allow 6 non-ambulatory residents to reside on the second floor until an updated fire clearance is approved.

LPM, LPA, Fire inspectors, Nisha, Knual, JR, and Susie completed a facility walk through. The Fire Inspectors discussed current fire violations. LPM and LPA noted an electronic wheelchair/scooter evacuation lift. The facility acknowledged that staff do not have training on the device. The facility agreed to train all staff immediately on the usage of the stair lift and submit proof of training to the Department.

Exit interview conducted. A copy of this report was emailed to the facility.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
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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