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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045003022
Report Date: 08/16/2023
Date Signed: 08/16/2023 01:30:38 PM

Document Has Been Signed on 08/16/2023 01:30 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EMERALD DREAMCARE HOMEFACILITY NUMBER:
045003022
ADMINISTRATOR:MURILLO, AARONFACILITY TYPE:
740
ADDRESS:2289 BARTRIANGLE STREETTELEPHONE:
(925) 914-9470
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 6CENSUS: 5DATE:
08/16/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Administrator- Aaron MurilloTIME COMPLETED:
01:45 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 08/16/2023, Licensing Program Analyst (LPA) Jaynae Boyles and Licensing Program Manager (LPM) Lauren Crocker, arrived at the facility announced to conduct a Pre licensing Inspection. LPA's met with Facility Administrator, Aaron Murillo and explained the purpose of the visit.

LPA Boyles, LPM Crocker, and Administrator Murillo toured facility together to ensure that the facility is in compliance for seniors has a dementia. Areas toured include but are not limited to: common areas, bedrooms, backyard, and restrooms. LPA observed the facility to be clean, in good repair and odor-free with trash can with lids. The facility was equip with required fire extinguishers, fire detectors and carbon monoxide detectors. The facility was stocked with the required two day perishable and 7 day non-perishable amount of food for residents and staff.

Component III and proper documentation and storage of centrally stored medications will be conducted and reviewed after corrections are received via a virtual meeting.

The following items will need to be addressed prior to the facility getting licensed. These corrections are also documented on the current license- Golden Sierra Carehome Inc License #045002509 :

-The water temperature needs to be lowered to read between 105' F and 120' F.

-Current MD reports for all residents in care

-MD orders for residents with 1/2 rails (as postural supports)

-A lock in a residents room to the exterior has a lock rendering it inoperable - needs to be removed.

-All exits need to be alarmed and alarms need to be on at all times.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
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