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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701207
Report Date: 07/26/2023
Date Signed: 07/26/2023 10:58:59 AM

Document Has Been Signed on 07/26/2023 10:58 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:BELMARE SENIOR LIVINGFACILITY NUMBER:
502701207
ADMINISTRATOR:CINDY LICHTENHANFACILITY TYPE:
740
ADDRESS:1450 WEST F STREETTELEPHONE:
(209) 764-3164
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY: 72CENSUS: 57DATE:
07/26/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cindy LichtenhanTIME COMPLETED:
11:00 PM
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On 07/24/2023 unannounced annual inspection was made to this facility by Licensing Program Analyst (LPA) Kimberly Viarella. The LPA identified herself and the purpose of the visit and asked to speak to the Designated Facility Administrator. LPA was met by Cindy Lichtenhan, the new Designated Facility Administrator and a brief interview followed.

The tour began with resident accommodations. Rooms were clean and had adequate furniture and lighting. Each room had a private bathroom where grab bars and no-skid shower surfaces were observed. LPA observed toxins and personal hygiene items that were not approved of in the resident’s LIC 602. Staff immediately removed these items.
The kitchen was inaccessible to residents and clean and sanitary. The LPA observed 7 days of non-perishable and 2 days of perishable food supplies. Upon inspecting the reach-in refrigerator, the LPA selected 4 food packages, 2 were not securely closed and 1 was not dated. Staff immediately disposed of the items. The LPA inspected the pantry and freezers as well and they were found to be in compliance.
LPA observed smoke and carbon monoxide detectors throughout the facility and fire extinguishers were last inspected in January of 2023 by First Alert.
LPA toured the medication room. Policies and procedures were discussed and the EMAR system and logs were reviewed. Medications, including narcotics, were kept in a locked cart and distributed to residents on an individual basis as directed by their physicians. Omnicare performs audits of the medication room twice a year, the last one was performed in June 2023.

Due to time constraints this annual inspection will be continued at a later date. A copy of this report was provided to the Designated Facility Administrator.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: BELMARE SENIOR LIVING
FACILITY NUMBER: 502701207
VISIT DATE: 07/26/2023
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SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
LIC809 (FAS) - (06/04)
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