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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317003807
Report Date: 03/23/2023
Date Signed: 03/23/2023 02:26:19 PM

Document Has Been Signed on 03/23/2023 02:26 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:BADETTE'S PLACE INC.FACILITY NUMBER:
317003807
ADMINISTRATOR:CARRILLO, BLESFACILITY TYPE:
735
ADDRESS:9455 DUFFY LANETELEPHONE:
(916) 773-1925
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 4CENSUS: 4DATE:
03/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Bles Carrillo, Administrator TIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Bethany Huusfeldt made an unannounced visit today to conduct facilities required annual inspection. Administrator Bles Carrillo and Josefino Carrillo were present at the facility upon LPA's arrival. During today's visit, all clients except one were at Day Program. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

Administrator toured the facility with LPA. LPA inspected the interior and the exterior of the facility including the common living spaces, 3 client bedrooms and 2 bathrooms, kitchen, staff room and garage. Bathrooms and bedrooms were clean and in good repair. LPA toured the backyard and all exits are accessible and unlocked. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire drills are being conducted and documented. Administrator stated there are no COVID cases at the facility, and facility has sufficient amount of PPE. LPA observed an adequate amount of linens and found the first aid kit to be complete.

LPA reviewed 2 of 4 client records and 2 staff records. LPA reviewed medications of two clients comparing with physician orders and MAR and P&I money and documentation. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates and training is being conducted.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

Exit Interview conducted.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2023
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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