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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701286
Report Date: 06/13/2024
Date Signed: 06/13/2024 02:29:31 PM

Document Has Been Signed on 06/13/2024 02:29 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BEATRICE HOME CAREFACILITY NUMBER:
342701286
ADMINISTRATOR/
DIRECTOR:		CLARK, BEATRICEFACILITY TYPE:
740
ADDRESS:1014 FERNANDO WYTELEPHONE:
(916) 270-3961
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 6CENSUS: 5DATE:
06/13/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Beatrice Clark TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a Plan of Correction Visit. LPA Valerio met with facility staff Etta Mae, and explained the purpose of the visit. LPA was later met by Administrator Beatrice Clark.

The facility was cited on 05/29/2024 for 87307 Personal Accommodations and Services, 87705 Care of Persons with Dementia, and 87468.1 Personal Rights of Residents in All Facilities.

LPA Valerio observed the facility. LPA Valerio observed all beds to have clean a bed cover, bed linen, a blanket, and pillows. LPA observed the kitchen to have sharps locked away and inaccessible to residents in care. LPA observed cleaning supplies locked in the cabinets. LPA observed the housekeeper mopping the floors. LPA did not observe toxins accessible to residents .

Administrator Beatrice showed LPA a copy of the statement confirming an in-service training was held with facility staff for Personal Accommodations and Services, Care of Persons with Dementia, and Personal Rights of Residents in All Facilities.

An exit interview was held, and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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