<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701314
Report Date: 01/23/2025
Date Signed: 01/23/2025 01:23:04 PM

Document Has Been Signed on 01/23/2025 01:23 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:PRIMECARE SENIOR SERVICES LLCFACILITY NUMBER:
342701314
ADMINISTRATOR/
DIRECTOR:		KAGECHE, FRANCIS MFACILITY TYPE:
740
ADDRESS:3931 RILEY ANTON WAYTELEPHONE:
(916) 294-7388
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY: 4CENSUS: 4DATE:
01/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:12 AM
MET WITH:Francis Kageche TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 1/23/25. LPA identified herself to the caregiver on duty, explained the purpose of the visit, and asked to speak with Licensee/Administrator, Francis Kageche. The Caregiver called the Administrator and they arrived shortly after. LPA met with the Administrator and a brief interview followed.

LPA noted the Administrator/Licensee, Francis M. Kageche, certificate # 6046167740 expires on 11/27/25.

Upon entering the facility, LPA observed “See Something Say Something” sign, Resident Rights, Theft and Loss and Grievance Policies, a sample activities calendar, and the facility license. The Emergency Disaster plan along with Emergency phone numbers were also present at the time of this inspection.

The inspection began in the kitchen. All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. Opened packages in the refrigerator were dated appropriately. All dry goods were dated with best buy dates. A second freezer was located in the garage to store food for residents and a separate refrigerator stored employee items.



LPA inspected the 4 resident bedrooms and 2 bathrooms. All resident rooms had the required furniture, furnishings and lighting to be in compliance at this time.

LPA noted soap, paper towels and trash cans with lids in the bathrooms. The required grab bars were also present at the time of inspection. The hot water temperature was measured at 105.1 degrees Fahrenheit and was in compliance. The fire extinguisher was last serviced on 7/03/24 by Annual Fire Co.

The exterior of the building was inspected by the LPA. There were no bodies of water present and the yard was completely fenced in. LPA observed that all screens and gutters were in good repair. There was 1 storage shed with a lock that contained paint, wheel chairs, and storage items. There was also a covered patio area for residents to enjoy.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
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)
Page: 1 of 3
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: PRIMECARE SENIOR SERVICES LLC
FACILITY NUMBER: 342701314
VISIT DATE: 01/23/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The LPA observed medications were stored in 4 separate locked cabinets in the kitchen and inaccessible to residents in care. Medications were primarily the pill packs provided by the pharmacy. LPA reviewed storage, dosing, and destruction procedures. A review of the First Aid kit by the LPA found it to be complete and in compliance.

A file review was completed by the LPA which included 2 resident and 2 staff files. LPA provided technical assistance with some of the forms and the documents required for background clearances.

LPA requested the following:

LIC 500
LIC 9020
LIC 308
LIC 400
LIC 402
LIC 610E
Copy of Liability Insurance
Copy of the facility sketch
Copy of Admissions Agreement
Copy of Administrator's Certificate

According to the California Code of Regulations, Title 22, no deficiencies were cited during today's visit. A copy of this report was provided along with technical assistance. Exit interview.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
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)
Page: 2 of 3