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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 11:37:07 AM

Document Has Been Signed on 07/26/2023 11:37 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:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Cindy LichtenhanTIME COMPLETED:
11:30 AM
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On 07/26/2023 an unannounced case management – continued 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 LPA inspected the exterior of the facility. All windows and screens were in good repair. There were designated shaded outdoor spaces with seating for residents to enjoy. The walkways were clear of debris and accessible.

In addition, this LPA was shown that overnight staff had created labeled totes for each memory care resident to hold their personal hygiene items. These totes were stored in a locked closet and inaccessible to residents in care. They would be retrieved by caregivers for supervised use.

The LPA inspected the exterior of the facility. All windows and screens were in good repair. There were designated shaded outdoor spaces with seating for residents to enjoy. There was construction taking place as the facility was expanding and building a separate memory care building and independent living building on either side of the existing structure. At the present time, the walkways were clear of debris and accessible.

Common areas were toured as well. These included but were not limited to: the library, game room, bistro, theater, and gym. They each had sufficient lighting, furnishings, and furniture/equipment for their designated purposes.

The facility posts a calendar of monthly activities for residents. This LPA observed residents participating in activities in the game room, common areas, as well as the bistro. Residents in the memory care wing were
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2023
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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also involved in a variety of activities during the LPA’s inspection.

LPA conducted a resident file review and 4 out of 5 files did not contain a consent for treatment form as well as an inventory of residents’ personal items/valuables. It was noted that the 4 files were for residents who
had been admitted under a previous Designated Facility Administrator. The 5th file was complete and contained all of the necessary components. Prior to the completion of this inspection, the Designated Facility Administrator provided this LPA with new Consent Forms with each resident's name inserted along with any allergy information. The Administrator stated that they would be obtaining updated signatures for each file.

No deficiencies were observed pursuant to the California Code of Regulations, Title 22, Chapter 6.
Exit interview conducted and copy of report given to the Designated Facility Administrator.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC809 (FAS) - (06/04)
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