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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920034
Report Date: 07/20/2023
Date Signed: 07/20/2023 11:10:39 AM


Document Has Been Signed on 07/20/2023 11:10 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:VITAE HOME CAREFACILITY NUMBER:
315920034
ADMINISTRATOR:PETERSON, BRIGETTEFACILITY TYPE:
740
ADDRESS:6882 BRANDY CIRCLETELEPHONE:
(916) 797-6238
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:6CENSUS: 6DATE:
07/20/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Brigitte PetersonTIME COMPLETED:
11:30 AM
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On Thursday July 20, 2023, Licensing Program Analyst Melissa Parks arrived to conduct a prelicensing inspection with residents in care.

LPA toured the facility with current Licensee Elaine and Administrator Brigitte. This facility has a fire clearance for 5 non-ambulatory residents and 1 bedridden resident. There are 5 resident bedrooms and 1 staff bedroom. Showers have required nonskid mats. Kitchen is clean and organized. All knives and sharp objects are kept inaccessible to clients. All appliances in the kitchen are observed to be clean and operational. Toxins and cleaning supplies are inaccessible to residents. Medications are kept locked in a cabinet by the dining room table. Backyard was clear of debris and hazards.

Facility has one fire extinguishers with a current inspection. Facility has a fully stocked first aid kit.

Component III has been completed at this time with Administrator Brigitte.

The facility appears to be in substantial compliance and ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau.

An exit interview was conducted with Licensees and a copy of this report was emailed to the facility.

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023
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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