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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700681
Report Date: 09/20/2023
Date Signed: 09/29/2023 10:21:52 AM


Document Has Been Signed on 09/29/2023 10:21 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:NANNY'S NESTFACILITY NUMBER:
312700681
ADMINISTRATOR:BARNES, STACIFACILITY TYPE:
740
ADDRESS:2217 GLACIER DRIVETELEPHONE:
(916) 276-8763
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 6DATE:
09/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Bianca GhejuTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 9/20/23 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with Administrator and explained the purpose of the visit.

Facility in process of a change of ownership. Licensee will provide proof of current lease agreement covering the period until new applicant is licensed. Lease to be provided to LPA by 9/22/23.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, 4 resident bedrooms, 2 bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and designee discussed medication procedures of identifying medications when removed from the container and documenting PRN use.

LPA reviewed 6 resident files. Files were complete. LPA and designee discussed having meetings with residents or responsible parties to review care plans.
LPA reviewed 3 staff files. Files complete for forms and training. Licensee to associate on call staff S4.

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

Exit interview conducted. Report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2023
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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