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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700571
Report Date: 03/23/2023
Date Signed: 03/23/2023 03:22:35 PM


Document Has Been Signed on 03/23/2023 03:22 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:VITAE HOME CAREFACILITY NUMBER:
312700571
ADMINISTRATOR:TROSTINSKY, ELAINEFACILITY TYPE:
740
ADDRESS:6882 BRANDY CIRCLETELEPHONE:
(916) 797-6238
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:6CENSUS: 4DATE:
03/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Elaine TrostinskyTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Thursday March 23, 2023 to conduct the annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed resident (4) and staff files (2). All resident files contained the required paperwork. All staff files contained the required paperwork and training. Staff have current first aid and CPR training.

LPA Parks and Administrator Elaine toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, storage, and common areas. Water temperatures in kitchen and bathrooms were within the required range of temperatures. In the areas toured, there were no health or safety violations observed.

LPA obtained a copy of the current LIC610. Requesting an updated LIC500.

No deficiencies cited. Exit interview conducted. A copy of this report was left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
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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