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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000118
Report Date: 09/03/2021
Date Signed: 09/03/2021 01:49:07 PM

Document Has Been Signed on 09/03/2021 01:49 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:NUNEZ CARE HOME #2FACILITY NUMBER:
347000118
ADMINISTRATOR:NUNEZ, LEONIL AND RUBYFACILITY TYPE:
740
ADDRESS:8005 35TH AVENUETELEPHONE:
(916) 383-1437
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY: 3CENSUS: 3DATE:
09/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Lionel Nunez Jr TIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Anthony Tuck arrived to conduct an unannounced annual/random inspection on 09/03/2021. LPA met with Lionel Nunez and explained the purpose of the visit. Leonil Nunez is the Administrator and holds certificate #6053124735 that expires on 02/26/2022

This facility is a single story building licensed to serve three (3) ambulatory residents. LPA toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 118.2 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 10/31/2020 Thermostat observed at 74 degrees Fahrenheit. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. LPA reviewed staff associations to the facility. First aid kit was checked and is complete.

The following forms were received during today's visit on 09/03/2021:
LIC 308 copy of administrator certificate
LIC 500 copy of liability insurance
LIC 610

Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies were cited during today's visit. Exit interview held with Lionel Nunez and a copy of report given at the conclusion of the visit.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Anthony Tuck
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2021
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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