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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700012
Report Date: 09/17/2021
Date Signed: 09/17/2021 12:56:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:TWIN RIVERS AT NATOMASFACILITY NUMBER:
342700012
ADMINISTRATOR:VADAREVU, SITAFACILITY TYPE:
740
ADDRESS:421 SAN JUAN ROADTELEPHONE:
(916) 216-3058
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:48CENSUS: 33DATE:
09/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sita Vadarevu, AdministratorTIME COMPLETED:
01:15 PM
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On September 17, 2021, at 11:30am, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a case management visit. LPA met with Administrator Sita Vadarevu, and informed her the reason for the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms, and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) An N-95 mask was worn. Additionally, LPA was screened prior to entry.

Resident Leotis Owens continues to AWOL the facility when he is out of cigarettes. The administrator has written an eviction for him. The family members received the eviction. When resident runs out of cigarettes, he will leave the facility to buy more. The facility staff will follow him to ensure his safety. The family states they will not take him out of the facility because he has no where else to go. No other care homes will accept him and he will eventually be homeless.

LPA will consult with her manager as to what more can be done for this resident.

No citations were issued.

An exit interview was conducted and a copy of this report was given to Sita Vadarevu.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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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