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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701286
Report Date: 07/02/2024
Date Signed: 07/02/2024 11:26:38 AM

Document Has Been Signed on 07/02/2024 11:26 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: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:
07/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Beatrice Clark TIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required visit. LPA Valerio met with facility staff Etta M., and explained the purpose of the visit. LPA Valerio was later met by Administrator Beatrice Clark.

LPA Valerio observed facility staff serving breakfast to residents, cleaning the facility, and assisting residents with ADLs. LPA Valerio toured the physical plant to ensure compliance with Title 22 regulations. LPA Valerio observed the kitchen to be clean. The facility was observed to have an adequate supply of food. LPA Valerio observed residents bedrooms to be fully furnished, clean, and free from odors. Beds were observed to have clean sheets, blankets, and pillow covers. LPA Valerio observed two resident bathrooms. The bathroom located in room 3 had a recent repair of the shower floor. According to the Administrator, the shower is off limits until the floor is completely fixed. LPA Valerio took a picture for reference. The second bathroom located outside of resident bedrooms was observed to be fully operational. Hot water was measured at 115.0 degree F. The temperature inside the home was 70 degrees F. Door alarms were observed to be in working condition. Carbon monoxide detector, fire extinguisher, and fire detector were in working condition and had a last annual inspection on 04/15/2024.

LPA Valerio reviewed 3 staff files. 3 out of 3 staff files did not have an active first aid certificate. Staff completed CPR/First aid prior to LPA's departure from the facility. A Technical Violation Advisory Note was provided to Administrator Beatrice. LPA Valerio reviewed 5 resident files. 5 out of 5 resident files had an up to date assessment and appraisal. LPA Valerio requested the following annual documentation be sent to the Regional Office by 07/12/2024: LIC 500, LIC 308, LIC 610D

Per California Code of Regulations (CCR) - no deficiencies are being cited on today's visit. A Technician Violation Advisory Note was provided. An exit interview was held with Administrator Beatrice, and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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