342700012-5-15-2024-59-AS-DAWL-D5AQ8G-20240515115642

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700012
Report Date: 05/15/2024
Date Signed: 05/15/2024 11:56:58 AM

Document Has Been Signed on 05/15/2024 11:56 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	TWIN RIVERS AT NATOMAS		FACILITY NUMBER:	342700012
ADMINISTRATOR:	GENAYA REESE		FACILITY TYPE:	740
ADDRESS:	421 SAN JUAN ROAD		TELEPHONE:	(916) 216-3058
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95834
CAPACITY:	48	CENSUS: 32	DATE:	05/15/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:57 AM
MET WITH:	Sita Vadarevu, Licensee		TIME COMPLETED:	12:22 PM

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On May 15, 2024, at 8:57 am, Licensing Program Analyst (LPA) De Anna Williams-Lyons arrived unannounced to conducted an Annual Inspection of the facility to ensure compliance with Title 22 regulations. LPA met with Sita Vadarevu, Licensee, who assisted LPA in today’s inspection. The Administrator certificate expires 7/25/25. The current census is 32. The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 75 degrees F which is within range.

Sita and LPA completed the inspection tool with no issues or concerns.

The facility is a one-story facility. Living rooms, dining room, and areas designated for resident use were toured. LPA inspected the interior and the exterior of the facility. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food.

There are 24 rooms. LPA inspected several rooms. All rooms had the required items of furniture. Window screens were on and in good repair. Bathrooms were clean, sanitary and odorless and consisted of grab bars and non-skid mats. The sink, toilet, and shower operate properly. The facility has a sufficient supply of linens, towels, bedding, etc. for residents in care.

To continue see 809....

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: TWIN RIVERS AT NATOMAS	FACILITY NUMBER: 342700012
	VISIT DATE: 05/15/2024

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Washer and dryer was present and operating properly. Toxic substances, laundry and cleaning supplies were inaccessible. There’s a centralized storage area for resident’s medication. The facility Medication Administration Record and the dispensing log was reviewed. No issues of concern. First aid kit was present and included the required scissors, tweezers, thermometer and guide. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguishers are maintained and ready for emergency use.

LPA reviewed 6 resident files and 3 staff files. Resident files are current and had all the required documents. Staff files reviewed revealed facility is conducting the required training, have Criminal Record Clearances and updated Emergency Contacts.

LPA interviewed residents for the infectious Control questionnaire.

The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file. Administrator shall submit the listed documents to Licensing no later than June 15,2024.

Per California Code of Regulations, Title 22, no citations were issued.

An exit interview was conducted and a copy of this report was given to Sita.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC809 (FAS) - (06/04)

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