312700395-2-11-2025-59-AS-CMIN-DDSULY-20250211144130

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 312700395
Report Date: 02/11/2025
Date Signed: 02/11/2025 02:41:44 PM

Document Has Been Signed on 02/11/2025 02:41 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:	A1SENIOR CARE		FACILITY NUMBER:	312700395
ADMINISTRATOR/ DIRECTOR:	TACANDONG, DAISYREE		FACILITY TYPE:	740
ADDRESS:	217 HINGHAM CT		TELEPHONE:	(916) 740-7715
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	02/11/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:35 PM
MET WITH:	Daisyree Tacandong, Administrator		TIME VISIT/ INSPECTION COMPLETED:	02:55 PM

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Licensing Program Analyst (LPA) Cassandra Mikkelson arrived unannounced and met with Administrator Daisyree Tacandong to conduct an annual inspection utilizing the inspection tool.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed four (4) resident rooms and three (3) common area bathrooms. LPA observed rooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 114.6 degrees F.

LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two day perishable and (7) seven day non-perishable food supply on hand. Smoke detectors and carbon monoxide detectors are operational in the care home. Fire extinguishers and first aid kit are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed six (6) resident files, two (2) staff files and six (6) resident medications.

Facility has a current copy of certificate of liability insurance and LPA requested a copy.

As a result of this visit, no deficiencies were cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted with Administrator.

Laura Munoz	TELEPHONE: (916) 263-4743
Cassandra Mikkelson	TELEPHONE: 916-709-6830
	DATE: 02/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

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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