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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701286
Report Date: 06/14/2023
Date Signed: 06/14/2023 12:16:44 PM

Document Has Been Signed on 06/14/2023 12:16 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:BEATRICE HOME CAREFACILITY NUMBER:
342701286
ADMINISTRATOR:CLARK, BEATRICEFACILITY TYPE:
740
ADDRESS:1014 FERNANDO WYTELEPHONE:
(916) 270-3961
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 6CENSUS: 0DATE:
06/14/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Beatrice ClarkTIME COMPLETED:
12:30 PM
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On 6-14-23 at approximately 9:05am, Licensing Program Analyst (LPA) Jennifer Fain and Licensing Program Manager (LPM) Liza King arrived at this facility announced to conduct a pre-licensing inspection visit. LPA and LPM met with the administrator, Beatrice Clark, and explained the purpose of the visit.

LPA and LPM inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations and Health and Safety Code. Facility is an RCFE facility for 6 residents, 6 of which may be non ambulatory, none may be bedridden. Facility has 5 bedrooms and 2 bathrooms for resident use. Facility has a dining area off the kitchen. The facility has intentions to provide care to dementia residents. The facility has an approved Infection Control plan in place. The facility has a central entry point and has sign in procedures at the front door area.
Room temperature reads 72*F. LPA and LPM observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were sanitary and furnished. Smoke and carbon detectors were tested and in good repair. Two fire extinguishers were observed and were found to be serviced 4-14-23. Facility has an exit door alert system. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. Facility rental agreement was reviewed and is good through 2027.

Facility does not contain any bodies of water. LPA observed personal rights, resident council and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance.

Continued on 809C
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Jennifer Fain
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286
VISIT DATE: 06/14/2023
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Pre-Licensing is incomplete with the following items to be resolved. A follow up Pre-licensure visit will be scheduled when the items are cleared.

LPA Fain and LPM King observed window screens missing or damaged in 3 bedrooms, kitchen, dining-room and bathroom.
LPA Fain and LPM King observed damaged light panels in kitchen.
LPA Fain and LPM King observed 2 of 2 fire doors are in need of thresholds.
LPA Fain and LPM King observed beds are in need of non permeable mattress pads.
LPA Fain and LPM King observed medical kit needs tweezers.
LPA Fain and LPM King observed closets and bathroom vanities needed to be cleared of items.
LPA Fain and LPM King observed painters paper and tape on ceiling light fixture outside of room 5.
LPA Fain and LPM King observed water temperature above 125*F. (regulation setting for water should be 105- 120*F)
LPA Fain and LPM King observed no privacy door to room 5. During the inspection the facility sketch was updated and a fire inspection was requested.

An exit interview was held and a report was given to Administrator Beatrice Clark
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Jennifer Fain
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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