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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003883
Report Date: 11/21/2024
Date Signed: 11/21/2024 04:15:30 PM

Document Has Been Signed on 11/21/2024 04:15 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MONTEREY, THEFACILITY NUMBER:
347003883
ADMINISTRATOR/
DIRECTOR:		DESCARGAR, BERNADETTEFACILITY TYPE:
740
ADDRESS:8700 SECKEL COURTTELEPHONE:
(916) 686-4836
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 6DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:34 PM
MET WITH:Bernadette DescargarTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On 11/21/24, Licensing Program Analyst (LPA) Arvin Villanueva arrived to the facility unannounced to conduct an annual required inspection. LPA met with Licensee/Administrator Bernadette Descargar and stated the purpose of the visit. Upon arrival, there were 6 residents in care with 2 staff on duty.

LPA evaluated the physical plant with Bernadette to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas.

The facility is a one-story home located in a residential neighborhood. Facility is fire cleared to retain/admit 6 non-ambulatory residents with approved hospice waiver for 6 residents. LPA observed the facility to be free of odor, clean and in good repair at this time. LPA observed 3 of 6 resident bedrooms to be equipped with the required furniture and sufficient lighting throughout the facility. Facility also has 2 staff bedrooms as indicated in the facility sketch. Facility also has 3 bathrooms. LPA observed 1 of 3 bathrooms and was observed to be equipped with slip resistant flooring and overall in good repair at this time. Hot water temperature in 1 resident bathroom was measured at 118 degrees F. Room temperature was observed at 73 degrees F. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers were observed and were last inspected on 1/23/24. Smoke and carbon monoxide detectors were observed. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. No bodies of water was observed at this time. Fireplace was observed to be screened and non-operational at this time. Fence and gates were observed to be in good repair at this time. LPA observed activity supplies for residents. LPA observed outdoor furniture and outdoor activity area was observed to be spacious for resident use.

Due to insufficient time, this annual visit requires a continuation visit.

Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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