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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003884
Report Date: 11/19/2024
Date Signed: 11/19/2024 04:08:13 PM

Document Has Been Signed on 11/19/2024 04:08 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:TAHOE, THEFACILITY NUMBER:
347003884
ADMINISTRATOR/
DIRECTOR:
DESCARGAR, BERNADETTEFACILITY TYPE:
740
ADDRESS:8708 SECKEL COURTTELEPHONE:
(916) 686-5715
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: DATE:
11/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
04:15 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 11/19/24, Licensing Program Analyst (LPA) Arvin Villanueva arrived to the facility unannounced to conduct an annual required inspection. LPA met with staff on duty (S1) and explained the purpose of the visit. The Licensee/Administrator Bernadette Descargar and Assistant Administrator Mary Jan Mitchell arrived shortly after. Upon arrival, there were 4 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. LPA observed the facility to be free of odor, clean and in good repair at this time. LPA observed 3 of 5 bedrooms to be equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the hot water temperature in 2 resident bathroom between 112 and 116 degrees F. Room temperature was observed at 73 degrees F. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Two fire extinguisher 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.

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: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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