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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700726
Report Date: 10/01/2024
Date Signed: 10/01/2024 12:57:22 PM


Document Has Been Signed on 10/01/2024 12:57 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:SWEET HOME OF ROCKLIN IIFACILITY NUMBER:
312700726
ADMINISTRATOR:LOPEZ, DOINAFACILITY TYPE:
740
ADDRESS:1622 ALBATROSS WAYTELEPHONE:
(916) 781-9170
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:6CENSUS: 5DATE:
10/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Diona LopezTIME COMPLETED:
01:10 PM
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On 10/1/2024, Licensing Program Analysts (LPAs) Graham Gunby and Cheyenne Ratajczak arrived to the facility unannounced to conduct a Required 1- year annual inspection. LPAs conducted an interview with the Administrator.

During today's inspection, LPAs and Administrator conducted a tour of the exterior and interior of facility to ensure the health and safety of residents in care. Areas toured included but not limited to: residents bedrooms, bathroom, kitchen, backyard and the common areas. LPAs observed toxins, medication and sharps to be locked and secured. LPAs completed the CARE tool and found the facility to be in compliance.

LPAs reviewed (5) resident files and (3) staff files. All files have the correct documents and are in compliance.

Exit interview was conducted. No deficiencies cited at this time.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Graham GunbyTELEPHONE: (916) 827-6870
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2024
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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