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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 090312340
Report Date: 07/24/2023
Date Signed: 07/24/2023 11:58:47 AM

Document Has Been Signed on 07/24/2023 11:58 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EL DORADO COUNTY SENIOR DAY CARE CENTERFACILITY NUMBER:
090312340
ADMINISTRATOR:WILSON, NANCYFACILITY TYPE:
775
ADDRESS:935-A SPRING STREETTELEPHONE:
(530) 621-6180
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY: 60CENSUS: 15DATE:
07/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Program Aid Sandy AngusTIME COMPLETED:
12:00 PM
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On 7/24/2023 Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to conduct an annual visit. LPA met with Program Aid Sandy Angus and explained the purpose of the visit.

LPA and Program Aid toured facility together to ensure health and safety of clients in care. Areas toured include but are not limited to: bathrooms, classrooms, hallways, kitchen and outside grounds.. LPA reviewed 5 client files and 2 staff files. All files contained the required paperwork. Water temperature was within the required temperature range. First Aid kit was fully stocked. All cleaning chemicals and laundry supplies were kept locked.

Administrator agreed to send updated LIC500 and LIC610 by 8/11/23.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report was emailed to Administrator.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
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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