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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700570
Report Date: 08/20/2022
Date Signed: 08/20/2022 01:33:07 PM

Document Has Been Signed on 08/20/2022 01:33 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SEN'S CAREGIVINGFACILITY NUMBER:
342700570
ADMINISTRATOR:PRASAD, INDRA SENFACILITY TYPE:
740
ADDRESS:5250 SHORTWAY DRTELEPHONE:
(916) 471-9145
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 6CENSUS: 5DATE:
08/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:care staff Parmila ChettyTIME COMPLETED:
02:00 PM
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LPA Jason Lund arrived at the above facility unannounced to conduct an annual/required visit. LPA was met care staff Parmila Chetty. LPA Jason Lund explained the reason for the visit. Facility Administrator Indra Sen Prasad was out with resident. LPA was screened upon entry for COVID precautions. census of 5.

LPA Lund and care staff Parmila Chetty toured the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations.

There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. The hallway has COVID precautions in place including social distancing noted. Chemicals and medications were noted to not be accessible to residents in care. The facility has central entry point and has implemented screening and sign in procedures at the front door area. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2-days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings.

The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked March 14, 2022. Facility has an emergency food and water supply in a seperate storage area in kitchen.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to care staff Parmila Chetty.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2022
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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