<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700815
Report Date: 04/03/2024
Date Signed: 04/03/2024 04:25:18 PM

Document Has Been Signed on 04/03/2024 04:25 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:PRIME ADULT DEVELOPMENT INCFACILITY NUMBER:
312700815
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:
CHENKO, TANYAFACILITY TYPE:
775
ADDRESS:5935 PACIFIC STREETTELEPHONE:
(916) 740-5577
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 30CENSUS: 28DATE:
04/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Tanya Chenko, Administrator TIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Calzada arrived unannounced to conduct an annual inspection and met with Tanya Chenko, Administrator, stating the reason for the inspection. LPA observed (7) staff members and the Administrator engaging in activities with the clients at the start of the inspection. LPA interviewed (3) clients prior to them departing from 1:30 -2:00 pm. The location is licensed for an adult day program for (30) clients, all of whom must be ambulatory. LPA observed all clients to be ambulatory.

LPA, Administrator and Zana Binevskiy, Coordinator, toured the interior and exterior of the facility, including the common activity rooms, quiet room, kitchen area, and bathrooms. There were no immediate health, safety, or personal rights violations observed. The facility appeared to be clean and free from odors. There is a locked area for toxins in the kitchen and tables/chairs for clients to bring their own lunch/snacks.

The fire extinguishers were last serviced 6/26/23 and are scheduled for re-servicing in June 2024. Emergency exit was clear and accessible. The First Aid kit was complete and there is sufficient PPE on hand. Program Rules and Personal Rights are posted along with volunteer schedule and activity calendar. Hot water measured 118*F in the kitchen.

LPA reviewed (7) client files. All files contained current paperwork and were organized and complete. There is (1) client that takes medication. The medication is locked in the office area and documentation is maintained when the medication is administered. LPA reviewed (6) staff files. All staff is cleared/associated to the facility. All staff have current First Aid/CPR certification on file and have completed required hours within the last year. The Administrator has a current Adult Residential Certificate #7000553735- exp 5/24/25. The Infection Control Plan was reviewed/approved. Discussed other related topics during today's inspection.

There are no deficiencies being cited as a result of todays inspection. Exit interview conducted.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1