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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700005
Report Date: 10/20/2021
Date Signed: 10/20/2021 04:54:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:REVERE COURTFACILITY NUMBER:
342700005
ADMINISTRATOR:CHAPPELL, BRENDAFACILITY TYPE:
740
ADDRESS:7707 RUSH RIVER DRIVETELEPHONE:
(916) 392-3510
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:72CENSUS: 71DATE:
10/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Brenda ChappellTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 10/20/21 at 1:20pm on a subsequent visit. LPA was allowed entry into the facility that is licensed for a capacity of 72. LPA met with Brenda Chappell and stated the purpose of todays visit. LPA observed residents are present during this visit.

LPA toured and inspected the physical plant inside to ensure there are no safety hazards to residents. The temperature inside the cottages measured at ranges 72-77*F which is within the required range of 68-85*F. There are 4 cottages on the premises, the hot water temperature was measured between 88-123*F in a random amount of rooms and the kitchen area. The Administrator will research the hot water heaters system to ensure the range is between the required range of 105-120*F and post caution signs until the system is normalized. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, central heating and air and a pull alarm system in the facility.

LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.


Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit. Exit interview held, copy of report given.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
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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