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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701315
Report Date: 10/02/2024
Date Signed: 10/02/2024 11:19:03 AM

Document Has Been Signed on 10/02/2024 11:19 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:QUINLEY SENIOR CAREFACILITY NUMBER:
342701315
ADMINISTRATOR/
DIRECTOR:		CARPIO, KATHERINEFACILITY TYPE:
740
ADDRESS:8712 VIA ALTA WAYTELEPHONE:
(916) 594-5353
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 1DATE:
10/02/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:39 AM
MET WITH:Kathrine CaprioTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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
On 10/2/24, at 9:39am, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced at this facility to conduct their post-licensing visit. LPA met with facility Administrator, Katherine Caprio (AD) and explained the purpose of the visit. During this visit, there were 1 resident in care with 2 staff on duty.

LPA inspected the physical plant of the facility. The facility is a one-story home located in a residential neighborhood. Front yard and backyard were observed to be clean and free of obstruction. LPA observed a covered patio at the back with outdoor furniture for clients use. The facility does not have bodies of water at this time. Fences and gate were in good repair.

Four client bedrooms were inspected and observed to be clean and large enough space to accommodate client belongings. Two bathrooms were inspected and observed to be clean and in good repair. The kitchen was inspected and observed to be sanitized and in good repair. Facility maintains an adequate amount of food supply with 2-day perishables and 7-day nonperishables. Smoke detectors and carbon monoxide monitor were observed. Sharps, toxins and medications were observed to be locked and inaccessible to residents. Facility was observed to have adequate supply of linens for clients. Fire extinguisher was observed at the kitchen area and last serviced on 8/30/24. Room temperature was at 72*F and hot water temperature was at 119.8*F in master bathroom. Fireplace was observed to be properly screened.
LPA reviewed 1 of 1 client records and found to be in compliance at this time. LPA reviewed 2 personnel records and were found to be in compliance at this time with current 1st Aid/CPR certificates, and background clearances. Facility conducts monthly emergency drills with last drill was conducted on 9/3/24. No changes to the facility sketch were observed.
Copy of the following documents were requested to be emailed during this visit: current Liability Insurance Certificate, Surety Bond, LIC500, LIC308.
Based on today's inspection, per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies were observed or cited. Exit interview held with AD, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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 1