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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005479
Report Date: 08/30/2023
Date Signed: 08/30/2023 10:19:22 AM

Document Has Been Signed on 08/30/2023 10:19 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:RENAISSANCE SENIOR CAREFACILITY NUMBER:
347005479
ADMINISTRATOR:LILLI LAPADATFACILITY TYPE:
740
ADDRESS:7316 MAIN AVENUETELEPHONE:
(916) 932-4303
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 6CENSUS: 6DATE:
08/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Lilli LapadatTIME COMPLETED:
10:30 AM
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 08/30/23, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct a required annual inspection. LPA met with administrator, Lilli Lapadat and explained purpose of inspection.

LPA and Administrator toured the interior and exterior of the facility including the common areas, residents bedrooms and bathrooms, kitchen, laundry area, medication room, staff room and outside area. LPA observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various infection control posters throughout as well as other required postings, including House Rules and personal rights. Inside temperature was observed to be 73* F. Fire extinguisher is ready for emergency use. Facility conducts quarterly fire and disaster drills. The facility has a large back yard area with seating. There are no pools/ponds. LPA observed locked toxins in the laundry area and locked medications in a separate room. LPA observed sufficient 2+day perishable/7+day non-perishable food and sufficient PPE on hand. LPA observed paper towels, soap, sanitizer, trash cans and hand-washing posters in the bathroom. Water temperature measured 111F* in the kitchen. Smoke/monoxide alarms were in working order.

LPA reviewed 2 residents and 2 staff files. LPA reviewed medications of 2 residents comparing with physician orders and find no errors. All residents files have required paperwork. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates and training completed.

No deficiencies were observed or cited today. Exit interview conducted.
A copy of this report was printed and given to Administrator.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
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