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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315003016
Report Date: 11/20/2024
Date Signed: 11/20/2024 12:58:46 PM

Document Has Been Signed on 11/20/2024 12:58 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:SENIOR CARE VILLA OF LOOMISFACILITY NUMBER:
315003016
ADMINISTRATOR/
DIRECTOR:		ILONA CORPUSFACILITY TYPE:
740
ADDRESS:3400 CHISOM TRAILTELEPHONE:
(916) 652-8000
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY: 27CENSUS: 13DATE:
11/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Ilona CorpusTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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Licensing Program Analysts (LPAs) Graham Gunby and Cheyenne Ratajczak arrived on Wednesday November 20, 2024 to conduct the unannounced annual inspection. LPAs met with Executive Director (ED) Ilona Corpus and explained the purpose of visit.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPAs reviewed resident (7) and staff (5) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training.

LPAs and Executive Director Ilona toured the facility together to ensure the health and safety of residents in care. The areas toured included common areas, bedrooms, bathrooms, kitchen, laundry room, front yard and back yard. All chemicals, toxins and sharps were kept locked and inaccessible to clients. Facility has updated fire extinguishers. In the areas toured, there were no health or safety violations observed.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the ED.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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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