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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002985
Report Date: 04/04/2023
Date Signed: 04/04/2023 12:45:32 PM

Document Has Been Signed on 04/04/2023 12:45 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:VILLA ELISA-FOLSOMFACILITY NUMBER:
345002985
ADMINISTRATOR:WORSFOLD, MAGGIE POSADASFACILITY TYPE:
740
ADDRESS:124 HILLSWOOD DRIVETELEPHONE:
(916) 932-4461
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 6CENSUS: 5DATE:
04/04/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Maggie Posadas WorsfoldTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Lavinia Muscan met with applicant, Maggie Posadas Worsfold, to conduct an announced Pre- Licensing visit. LPA wore a surgical mask. This application is a change in ownership. Applicant holds a current administrator certificate (# 6060796740 with expiration date 5/9/2024).

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. Facility inspection is done for these areas but not limited to six (6) bedrooms , four (4) bathrooms, storage area, outside area and laundry area . Bathrooms and bedrooms were in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors at the care home are operational. Fire extinguisher is ready for emergency use. Facility was approved for 6 non-ambulatory residents. Water temperature read within compliance.

Component III for RCFE was completed with Administrator during today's visit. LPA will forward findings to the Centralized Application Bureau (CAB) that facility met all the pre-licensing components.

Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations on today's pre-licensing inspection. A copy of this report was provided to the facility. Exit interview conducted.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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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