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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005202
Report Date: 03/10/2022
Date Signed: 03/10/2022 10:52:22 AM

Document Has Been Signed on 03/10/2022 10:52 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ST. CHRISTOPHER MANORFACILITY NUMBER:
347005202
ADMINISTRATOR:BENITEZ, NORMAFACILITY TYPE:
740
ADDRESS:8564 BRENTWICK WAYTELEPHONE:
(916) 525-1757
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 4CENSUS: 4DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Norma BenitezTIME COMPLETED:
11:00 AM
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LPA toured and inspected the physical plant inside and outside to ensure all passageways, and other areas of potential hazard are free of obstruction. LPA observed the kitchen and dining area for the ability to prepare food. LPA observed kitchen, dining area, bedrooms and bathrooms, Licensing Program Analyst (LPA) Jamie Ivey Canady and Christina Valerio arrived unannounced to conduct a Required Annual Inspection on 3/10/2022 at 9:00 am. LPA was allowed entry into the building. LPA met with Norma Benitez, administrator. All the residents were present during this visit. All residents are non-ambulatory.

Administrator certificate expires 11/30/2022 .
storage areas, laundry and lighting throughout the facility. The temperature inside the building measured at 75*F which is within the required range of 68-85*F. The hot water temperature was measured at 118*F which is within the required range of 105-120*F.

The first aid kit included supplies such as sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed the fire extinguisher(s), smoke detectors. Facility has central heating and air.

At 9:30 am one resident files and one staff files were reviewed during this visit.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no violations were observed during this visit. Exit interview held, copy of report given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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