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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920117
Report Date: 09/17/2024
Date Signed: 09/17/2024 11:55:49 AM

Document Has Been Signed on 09/17/2024 11:55 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:RAI ANGELSFACILITY NUMBER:
345920117
ADMINISTRATOR/
DIRECTOR:		RAI, BALWINDERFACILITY TYPE:
740
ADDRESS:6613 TRILBY CT.TELEPHONE:
(916) 945-2122
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 3DATE:
09/17/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Balwinder Rai, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection. LPA met with Karen Mayers, caregiver, who contacted Administrator, Balwinder Rai, who arrived at 11:30 am.

The first resident moved in on/around 5/31/24. A Post-Licensing has not been conducted.

LPA and Administrator conducted a tour of the interior of the facility and inspected the physical plant, kitchen, bedrooms, bathrooms, laundry area, and backyard area. LPA observed the facility to be free of odor, clean and in good repair. There is sufficient furniture and lighting throughout the facility. LPA observed required 7 day non-perishable and 2 day perishable food. LPA observed locked medications, knives and toxins to be inaccessible to residents. LPA observed (3) resident files to be organized and complete.

LPA observed all required postings to be posted.

There are no deficiencies being cited.

Exit interview. Copy of report provided to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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