342700286-3-28-2024-59-AS-DAWL-D3SPYP-20240328114417

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700286
Report Date: 03/28/2024
Date Signed: 03/28/2024 11:44:24 AM

Document Has Been Signed on 03/28/2024 11:44 AM - 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:	ORBISON OASIS HOME CARE LLC		FACILITY NUMBER:	342700286
ADMINISTRATOR:	BORODI, EMANUELA		FACILITY TYPE:	740
ADDRESS:	1068 ORBISON CT		TELEPHONE:	(916) 340-4353
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY: 6		CENSUS: 4	DATE:	03/28/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Emanuela, Borodi, Administrator		TIME COMPLETED:	12:00 PM

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On March 28, 2024 at 9:00am Licensing Program Analyst (LPA) De Anna Williams-Lyons arrived unannounced to conduct an Annual Required Inspection of the facility to ensure compliance with Title 22 regulations. LPA Lyons met with Emanuela Bordi, Administrator, and explained the reason for the visit. Emanuela certificate is valid expiring 5/29/25.

Emanuela and LPA did not conduct the Inspection Tool. LPA was having computer issues.

.LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. LPA observed there to be 7 sufficient amount of 2-day perishable and 7-day non-perishable food. Hot water temperatures were taken and measured at 105 degrees F, which is within the allowed range of 105-120 degrees. There’s appropriate lighting throughout the facility.

Living room, dining room, and areas designated for resident use were toured. Furniture and furnishings were observed to be enough and in good repair. Resident bedrooms and bathrooms were toured. Bedrooms had all the required items of furniture. Window screens were on and in good repair. Bathrooms were clean, sanitary and odorless and consisted of grab bars and non-skid mats. The sink, toilet, bathtub and shower operate properly. The facility has a sufficient supply of linens, towels, bedding, etc. for residents in care. Washer and dryer were present and operating properly. Toxic substances, laundry and cleaning supplies are inaccessible.

To continue see 809 C...

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ORBISON OASIS HOME CARE LLC	FACILITY NUMBER: 342700286
	VISIT DATE: 03/28/2024

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First aid kit was present and included the required scissors, tweezers, thermometer and guide. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguisher is maintained and ready for emergency use. LPA inspected the exterior grounds of this facility. There are bodies of water on the premises with locks in the appropriate places. The perimeter fence, side gates, and latches were in good repair.

There’s a centralized storage area for resident’s medication. Medication cabinet was locked. The facility does not use MARS, however the Medication log was reviewed and was complete and current.

Four Resident’s files were reviewed. All Documents were present and up to date.

Facility is conducting staff training as required.

Per the California Code of Regulations, Title 22, Division 6, to 8, no violations were observed.

An exit interview was conducted and a copy this report was given to Emanuela.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC809 (FAS) - (06/04)

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