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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920019
Report Date: 07/01/2024
Date Signed: 07/01/2024 03:26:49 PM

Document Has Been Signed on 07/01/2024 03:26 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:ARJAN CARE HOMEFACILITY NUMBER:
345920019
ADMINISTRATOR/
DIRECTOR:
BHANDAL, SARVEJEETFACILITY TYPE:
740
ADDRESS:9320 PALMERSON DRIVETELEPHONE:
(916) 494-1481
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 6CENSUS: 3DATE:
07/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Administrator- Sarvejeet BhandalTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 07/01/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with Administrator, Sarvejeet Bhandal and explained the purpose of the visit.

LPA and Administrator toured the interior and exterior of the facility. Areas toured include but are not limited to: common areas, residents' bedrooms, bathrooms, kitchen, garage and backyard. LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed residents' bathrooms to be clean, sanitary, and in good repair. LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Toxins, cleaning supplies and knives are locked and inaccessible to residents in care. The hot water temperature was measured in the kitchen at 119.1 degrees Fahrenheit. The temperature in the facility was 74 degrees Fahrenheit. First aid kit was completed. LPA observed fire detectors and carbon monoxide alarms to be operable. The fire extinguisher was last serviced on 05/20/2024. LPA observed medications to be locked and inaccessible to residents in care.
LPA reviewed a total of three (3) resident files. Resident files contain signed admission agreements, physician's reports, appraisals, identification sheets, releases, and resident's rights. LPA reviewed a total of one (1) staff record. Staff has training in infection control, first aid, and other various areas of care provision.

LPA requested Administrator to send updated copies of the following by 07/08/24 to LPA
  • LIC308- Designation of Administrative Responsibility
  • Liability insurance
  • Administrator Certificate

No deficiencies being cited during today's inspection.

Exit interview conducted and a copy of the report was left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2024
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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