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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005394
Report Date: 09/12/2024
Date Signed: 09/12/2024 12:29:07 PM


Document Has Been Signed on 09/12/2024 12:29 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:SAINT TROPEZ SENIOR CAREFACILITY NUMBER:
317005394
ADMINISTRATOR:HOBJILA, FLORINELFACILITY TYPE:
740
ADDRESS:245 SAINT TROPEZ LANETELEPHONE:
(916) 521-5152
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:6CENSUS: 4DATE:
09/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Florinel HobjilaTIME COMPLETED:
12:40 PM
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Licensing Program Analysts (LPA) Graham Gunby and Kerry Hiratsuka arrived on Thursday September 12, 2024 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (3) and staff (3) files. All resident files contained the required paperwork. All staff files contained the required paperwork. Facility is compliant with fire drills.

LPA and Administrator Florinel toured the facility together to ensure the health and safety of residents in care. The areas toured included resident bedrooms, resident bathrooms, kitchen, and outside property. Facility has all required postings. All water temperatures were within the required range. Facility has a fully stocked first aid kit. In the areas toured, there were no health or safety violations observed.

No deficiencies cited. Exit interview conducted. A copy of this report was left with the facility.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2024
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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