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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317699
Report Date: 05/16/2024
Date Signed: 05/16/2024 11:52:09 AM

Document Has Been Signed on 05/16/2024 11:52 AM - 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PRAISE CARE HOMEFACILITY NUMBER:
340317699
ADMINISTRATOR/
DIRECTOR:		ARTURO MERCADOFACILITY TYPE:
735
ADDRESS:4600 PARKER AVENUETELEPHONE:
(916) 803-5864
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 36CENSUS: 30DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:29 AM
MET WITH:Cora EpiscopeTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On 05/16/2024 at 8:29 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with lead housekeeper, Dominador Episcope who then called the House Manager, Cora Episcope. House Manager Cora and Hyacinth Hogan assisted LPA Lee with today’s annual inspection visit. The current census is 30 with 7 facility staff.

This facility is a single story building licensed to serve thirty-six (36) ambulatory mentally disabled clients. LPA Lee inspected the physical plant including but not limited to the 3-living area, lobby area, craft area, sitting/TV room, kitchen, dining area, 8 client bedrooms, 3 client bathrooms, laundry room, live in staff rooms and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present.

LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured in client bathroom #1 at 90.1 degrees Fahrenheit and client bathroom #6 at 91.1 degrees Fahrenheit which is not within the required regulation of 105 to 120 degrees Fahrenheit. During today’s visit, House Manager adjusted the water temperature and LPA Lee rechecked both client bathrooms. Client bathroom#1 water measured at 106.3 degrees Fahrenheit and client bathroom #6 measured at 105.8 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. One of the extinguisher is located in kitchen and 7 other fire extinguishers are located throughout the facility hall which leads to clients’ bedrooms. Fire extinguisher was last serviced on 01/17/2024. The last fire drill was conducted on 03/14/2024. LPA Lee observed the facility has a has a public telephone in the lobby area for client to use.

Continued LIC 809-C
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PRAISE CARE HOME
FACILITY NUMBER: 340317699
VISIT DATE: 05/16/2024
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 Facility thermostat observed at 73 degrees Fahrenheit. LPA Lee observed toxins located in the laundry room and kept locked and inaccessible to clients. LPA Lee observed sharp knives kept locked and inaccessible to clients. LPA Lee checked medication storage and found medication to be locked away and inaccessible to clients. LPA Lee reviewed and compared 7 medication administration record (MAR) and it was complete. The first aid kit was checked and contained all of the required components. LPA Lee requested client and staff files for review. LPA Lee reviewed 7 client files and 3 staff files, and they were complete. LPA Lee reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility.

The following documents will be email to LPA Lee by 05/21/2024 end of day 5:00 PM:


(1) LIC 308 Designation of Administrative Responsibility
(2) Copy of Administrator Certificate
(4) LIC 610 Emergency Disaster Plan
(5) Proof of Current Liability Insurance
(6) Current LIC 500 with all staff work hours

Per California Code of Regulations, Title 22, no deficiencies were cited. A technical advisory was given. An exit interview was conducted with House Manager Cora and a copy of this report was provided.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
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