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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001696
Report Date: 03/27/2024
Date Signed: 03/27/2024 02:19:21 PM

Document Has Been Signed on 03/27/2024 02:19 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:LA HONDA GUEST HOMEFACILITY NUMBER:
347001696
ADMINISTRATOR:TORRES, MARGARITAFACILITY TYPE:
740
ADDRESS:3940 LA HONDA WAYTELEPHONE:
(916) 944-8909
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 5DATE:
03/27/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Neal TorresTIME COMPLETED:
12:30 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
On 3/27/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to continue an annual inspection from incomplete visit of 3/14/2024. LPA met with Licensee, Neal Torres, and explained the purpose of the visit.

Note: time of visit was extended, due to technical difficulties resulting LPA to regenerate a new report.

Facility is licensed for six non-ambulatory, who one may be bedridden. Facility currently has five residents in care with no residents on hospice services.

During today's inspection, LPA observed three residents in the common area eating, and two residents in their private rooms. LPA observed three bathrooms, five residents room, laundry room, garage, staff room, backyard, kitchen and the common areas. In areas toured, no immediate health, safety, personal rights violations observed.

File review conducted for three residents and three staff. LPA observed annual training to be missing for S1, S2, and S3. LPA was informed Administrator has placed annual training binder in an unknown location. Administrator was unavailable during time of visit. LPA provided facility a copy of updated facility license and Health & Safety Code 1569.625 Staff training; legislative findings; contents.

Full CARE tool was completed with Licensee.

At this time, LPA is requesting a copy of staff annual training, facility liability insurance and LIC 500 to be submitted to LPA by Friday April 5, 2024.

Exit interview. A copy of the report provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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