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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700012
Report Date: 03/16/2022
Date Signed: 03/16/2022 02:09:59 PM


Document Has Been Signed on 03/16/2022 02:09 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:TWIN RIVERS AT NATOMASFACILITY NUMBER:
342700012
ADMINISTRATOR:GENAYA REESEFACILITY TYPE:
740
ADDRESS:421 SAN JUAN ROADTELEPHONE:
(916) 216-3058
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:48CENSUS: 32DATE:
03/16/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:Sita Vadarevu, LicenseeTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) DeAnna Williams arrived at the facility unannounced on 3/16/2022 to conduct a Required Year Inspection utilizing the infection control domain, LPA met with Sita Executive Director, and explained the purpose of the visit.

Prior to initiating the annual inspection, 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 contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA

LPA and Executive Director completed the infection control domain together and facility was found to be in substantial compliance at this time. The administrator certificate if valid expiring 7/25/23.

LPA and Executive Director toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, Fire extinguisher were charged and ready for emergency use. Facility had the required 2 day perishables and 7 day non-perishables food.
First aid kit was completed. Medications were properly stored away.

Per California of Regulations Title 22, No citations was issued..

Executive Director to send in updated copy of LIC 500 - Personnel Report, and current copy of Liability Insurance to Community Care Licensing by 04/17/2022.

An exit interview was conducted and a copy of this report was given to Sita.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2022
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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