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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920095
Report Date: 05/23/2024
Date Signed: 05/23/2024 02:17:49 PM


Document Has Been Signed on 05/23/2024 02:17 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:GS CARE HOMESFACILITY NUMBER:
315920095
ADMINISTRATOR:TALAMPAS, SOPHIA CFACILITY TYPE:
740
ADDRESS:8032 BOSSA NOVA WAYTELEPHONE:
(916) 588-5563
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: 0DATE:
05/23/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Sophia Talampas, LicenseeTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived announced to conduct the pre-licensing inspection. LPA met with Sophia Talampas during today's inspection. Currently there are no residents at the facility.

Facility was inspected both indoors and outdoors. LPA inspected 4 resident bedrooms, 2 bathrooms, common living areas, kitchen, garage, and outdoor areas. Outdoor area is free from hazardous debris. Outdoor exits are clear and accessible. First aid kit was present in the facility. Centrally stored medications will be locked in cabinet near the kitchen area. LPA inspected resident bedrooms and the bedroom had appropriate furnishings, adequate lighting and storage. Bathrooms are clean, sanitary, and in good repair. Grab bars and non-skid mat was present in all bathrooms. Smoke detectors and carbon monoxide detectors were checked. Fire clearance was granted on 04/29/24 for 6 non-ambulatory residents. Kitchen is clean, sanitary, and in good repair. A working telephone has be set up for residents use.

Licensee agrees to notify LPA once first consumer is admitted. This report will be forwarded to the centralized application unit for continued processing. Comp III was completed today during the inspection.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2024
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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