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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002947
Report Date: 10/31/2024
Date Signed: 10/31/2024 02:56:48 PM

Document Has Been Signed on 10/31/2024 02:56 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:J & H CARE HOMESFACILITY NUMBER:
345002947
ADMINISTRATOR/
DIRECTOR:
SALMAN, RASHAFACILITY TYPE:
740
ADDRESS:8529 ARROWROOT CIRCLETELEPHONE:
(916) 905-8038
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 6CENSUS: 5DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator- Rasha SalmanTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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On 10/31/24 Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to conduct a required 1 year annual inspection. LPAs met with Administrator Rasha Salman and explained the purpose of the visit.

LPAs and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited resident bedrooms, bathrooms, kitchen, common areas, and storage area. LPAs observed required furniture, and lighting throughout the residents' bedrooms and facility. LPAs observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Toxins and cleaning supplies are locked and inaccessible to residents in care. Hot water temperature was measured at 106 degrees Fahrenheit at the kitchen sink, which is within the required range of 105 to 120 degrees. LPAs observed fire detectors and carbon monoxide detectors to be operable. LPAs observed the fire extinguisher, located in hallway, which was last inspected on 09/16/2024. LPAs reviewed drill logs, which are conducted quarterly. LPAs observed required Licensing posters posted throughout the facility. First aid kit completed.

LPAs reviewed three (3) resident files and one (1) staff file all files contained the required documents. Medications are centrally stored, locked, and appear to be given per doctor order. LPAs compared medications to those being given for two (2) residents. Facility is correctly using the Medication Administration Records (MAR).

No deficiencies are being cited during today's inspection.

Exit interview conducted and copy of the report was left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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