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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920092
Report Date: 12/02/2024
Date Signed: 12/02/2024 05:09:25 PM

Document Has Been Signed on 12/02/2024 05:09 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:SAKURA HOME CAREFACILITY NUMBER:
315920092
ADMINISTRATOR/
DIRECTOR:
MALITSKIY, JULIEFACILITY TYPE:
740
ADDRESS:1220 HORTON LNTELEPHONE:
(279) 900-8464
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 6CENSUS: 3DATE:
12/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Julie MalitskiyTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Cassandra Mikkelson and Michael Hood arrived unannounced to conduct an annual inspection. LPAs met with Administrator Julie Malitskiy during today's inspection.

LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPAs observed six (6) resident rooms, one (1) staff room, and two (2) common area bathrooms. LPAs observed rooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained.

LPAs checked the kitchen area for the ability to prepare and store food. Care home has required (2) two day perishable and (7) seven day non-perishable food supply on hand. Smoke detectors and carbon monoxide detectors are operational in the care home. Fire extinguishers and first aid kit are maintained and ready for emergency use. LPAs checked medication storage and found medications to be locked away and inaccessible to the residents. LPAs reviewed three (3) resident files, three (3) staff files and two (2) resident medications. Facility has a current copy of certificate of liability insurance and LPAs obtained a copy.

As a result of this visit, no deficiencies were cited. Exit interview was conducted with Administrator.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2024
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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