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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005227
Report Date: 10/25/2023
Date Signed: 10/25/2023 03:36:17 PM


Document Has Been Signed on 10/25/2023 03:36 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:PAR PLACE SENIOR LIVINGFACILITY NUMBER:
317005227
ADMINISTRATOR:SANCHEZ, GERALDINEFACILITY TYPE:
740
ADDRESS:2407 PAR PLACETELEPHONE:
(916) 624-2985
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 6DATE:
10/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Geraldine "Gina" SanchezTIME COMPLETED:
03:45 PM
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On 10/25/23, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit while delivering complaint findings and met with licensee .

LPA and licensee discussed incident reports submitted regarding falls by R1, R2 and R3.
Care plans details, policies and training on policies/ procedures for determining wen to call PCP or emergency responders.

Current plans were discussed regarding R2 and R3.

The home is clean and resident care is provided for resident needs at this time.

As a result of today’s inspection, no deficiencies were noted.


Report reviewed. Copy of report and appeal rights provided
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023
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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