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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701168
Report Date: 09/22/2022
Date Signed: 09/22/2022 09:44:34 AM

Document Has Been Signed on 09/22/2022 09:44 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:YOUNG AT HEART RCFE NO.3 INCFACILITY NUMBER:
342701168
ADMINISTRATOR:SISAYAN, LILLIANFACILITY TYPE:
740
ADDRESS:9375 BROWNSBERG WAYTELEPHONE:
(916) 681-3689
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY: 6CENSUS: 5DATE:
09/22/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Glenda MolinyaweTIME COMPLETED:
09:50 AM
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On 9/22/22 at 9:00 PM Licensing Program Analyst (LPA) Chris Hopkins made an unannounced visit to conduct a health and safety check. A risk assessment call was performed prior to entry verifying there were no active covid cases. LPA met with Administrator Glenda Molinyawe.

This facility has a census of 5 residents. LPA toured the facility and observed two caregivers on duty not including Administrator, two residents in the living room, three residents in their bedroom. The facility is free of odor, clean, and in good repair. Health and Safety check today included overall safety of the facility including well-ness of staff and residents. Staff are sufficient in numbers and are doing fine. Residents are being well cared for and are happy residing in this facility. The current facility temperature is 75 degrees. The facility has sufficient seven-day non-perishable and two-day perishable food supplies.

No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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