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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317004845
Report Date: 03/29/2023
Date Signed: 03/29/2023 12:15:29 PM


Document Has Been Signed on 03/29/2023 12:15 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:AAA HOME CAREFACILITY NUMBER:
317004845
ADMINISTRATOR:FLORES, FRANKLYNFACILITY TYPE:
740
ADDRESS:6268 GRAND CANYON DR.TELEPHONE:
(916) 773-1207
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:5CENSUS: DATE:
03/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Franklyn Flores - licenseeTIME COMPLETED:
12:30 PM
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03/30/2023 09:35 AM Licensing Program Analyst (LPA) Rebecca Knight and Licensing Program Manager (LPM) Lauren Crocker arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA and LPM met with licensee Franklyn Flores Administrator cert 6018529740 exp.07/15/2024 and explained the purpose of the visit. Prior to initiating the annual inspection, LPA and LPM completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA and LPM donned the following Personal Protective Equipment (PPE) before entering the facility: N-95 mask, surgical mask.

LPA Knight, LPM Crocker and the licensee toured the facility together to ensure health and safety of residents in care. Areas toured include but are not limited to four (4) resident rooms, common areas, two (2) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. Medications were also reviewed.

Common area was clean and in good repair. All bedrooms had required furniture, bedding and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Facility has required (7) seven day non-perishable and (2) day perishable supply of food. Medication is locked in a locked closet.

Administrator certificate is current. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured and found to be low but licensee adjusted the water heater and the temperature was within the required range during the visit. All employees requiring background checks are cleared. All required postings are displayed within facility.

No deficiencies are being cited as a result of today’s inspection. Technical assistance was provided. Exit interview conducted and copy of report was provided to licensee Franklyn Flores.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2023
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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