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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701248
Report Date: 01/23/2025
Date Signed: 01/23/2025 11:58:09 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/23/2025 11:58 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SACRAMENTO SENIOR LIVING IIFACILITY NUMBER:
342701248
ADMINISTRATOR/
DIRECTOR:		LEWIS, SALOTEFACILITY TYPE:
740
ADDRESS:34 LOMA MAR CTTELEPHONE:
(530) 710-5707
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 6CENSUS: 5DATE:
01/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Netani Tuivu, Direct Service CaregiverTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct an annual inspection. LPA Campbell met with Netaim Tuivu, Caregiver and explained the purpose of the visit.

The facility is a one story building licensed to serve 6 ambulatory and non-ambulatory residents aged 60 and over, 2 of which may be hospice residents. Bedrooms #3, #4 and #5 can be used for non-ambulatory residents.

As observed by LPA Campbell, upon entry, LPA Campbell observed one client eating breakfast and another watching the news on television. There was one caregiver on duty with gloves on their hands washing dishes, mopping and putting away groceries and assisting clients. At LPA Campbell's request, staff provided staff and clients files for review.

LPA Campbell toured the facility and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas to ensure there are no safety hazards for residents. Furniture and furnishings were sufficient to meet the needs of residents. Bedrooms contained, beds, drawers, nightstand, lamp, chairs and closets. The facility temperature was 71 degrees Fahrenheit, which is within the required range of 68 and 85 degrees.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SACRAMENTO SENIOR LIVING II
FACILITY NUMBER: 342701248
VISIT DATE: 01/23/2025
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The facility's water temperature in the kitchen and bathroom measured 109 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. The backyard was toured by LPA Campbell. There are two emergency exits from the backyard to the street and pathways and exits were found to be clear.

LPA Campbell observed first aid supplies, a fully-charged and up-to-date fire extinguisher that was last inspected on 08/20/2024, and working carbon monoxide/smoke detectors. LPA Campbell observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Campbell observed locked cabinets for the storage of medication. LPA Campbell observed locked storage areas for the storage of cleaning solutions and knives as well in the laundry room above the washer. .

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was conducted with and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC809 (FAS) - (06/04)
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