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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701442
Report Date: 08/30/2024
Date Signed: 08/30/2024 11:30:04 AM

Document Has Been Signed on 08/30/2024 11:30 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:EZ CAREFACILITY NUMBER:
342701442
ADMINISTRATOR/
DIRECTOR:		KAKUTA, MODORIFACILITY TYPE:
740
ADDRESS:6240 FENNWOOD CT.TELEPHONE:
(916) 716-9596
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY: 6CENSUS: 0DATE:
08/30/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:01 AM
MET WITH:Modori KakutaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 8/30/24 at 9:00am Licensing Program Analyst (LPA) Kevin Gould arrived at EZ Care for the purpose of conducting a required 1 year annual inspection. LPA met with Applicant Khaula Nixon and current licensee and administrator Modori Katuka and together conducted a tour of the home. There are currently no residents in placement.

LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor and in good repair. LPA observed that one of the bedrooms requires a bed. All other required furniture was present in the facility. LPA observed a few light bulbs out and in need of replacement throughout the facility. all bedrooms and common areas bust be cleared of personal items not utilized for resident use or care.

LPA measured the water temperature, temperature measured at 111 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications area but requested a new lock as it appeared to be easily bypassed.

The following corrections are required prior to being licensed by the department: All light fixtures to be working and operational. Back bedroom requires a bed and all bedrooms and common areas need to have personal items removed. New lock on medications storage cabinet.

Per California Code of Regulations, Title 22 the facility does not meet all regulations to be licensed at the time of inspection. A follow up inspection has been scheduled for 9/11/24 at 1:00pm.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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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