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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 095002890
Report Date: 04/15/2024
Date Signed: 04/15/2024 02:30:59 PM

Document Has Been Signed on 04/15/2024 02:30 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:COMPASSION SPRINGS SRFFACILITY NUMBER:
095002890
ADMINISTRATOR/
DIRECTOR:		EZEANI, IFEANYIFACILITY TYPE:
772
ADDRESS:4229 TOYAN WAYTELEPHONE:
(916) 870-9676
CITY:DIAMOND SPRINGSSTATE: CAZIP CODE:
95619
CAPACITY: 6CENSUS: 6DATE:
04/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:House Manager Marissa HardyTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 4/15/24 Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to conduct an annual visit. LPA met with House Manager Marissa Hardy and explained the purpose of the visit.

LPA and House Manager Marissa Hardy toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, outside area and common restrooms. Facility has a 2 day perishable and a 7 day non-perishable amount of food. LPA reviewed 3 client files and 1 staff file. All files contained the required paperwork. First Aid kit was fully stocked. All cleaning chemicals and laundry supplies were kept locked. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for use.

LPA requested a copy of the LIC500, LIC610E and current liability insurance to be sent to the Department by end of the month.

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

Exit interview conducted and copy of report left with House Manager.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2024
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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