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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700024
Report Date: 08/05/2022
Date Signed: 08/05/2022 02:48:57 PM


Document Has Been Signed on 08/05/2022 02:48 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:WHOLESOME ELDERLY ON ARGOFACILITY NUMBER:
342700024
ADMINISTRATOR:FAAMAUSILI, CHRISTOPHERFACILITY TYPE:
740
ADDRESS:5205 ARGO WAYTELEPHONE:
(916) 823-5117
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:6CENSUS: 6DATE:
08/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator Kim BennettTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to conduct a annual/required inspection. LPA met with assistant administrator Kim Bennett and explained the reason for the visit.
LPA toured the facility and all required furniture were observed. LPA observed residents engaging in activity. LPA observed the facility conducts fire drills monthly. All bedrooms contained a dresser, bed, and nightstand. The flooring of the facility is a good condition. LPA observed the thermostat temperature inside the facility hallway was measured at 75 *F which is within the required range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature. LPA observed the centrally stored medications area to be locked and inaccessible to clients.
The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, central heating and air in the facility.
LPA observed there were food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times.LPA observed the backyard area in good condition. The facility was clean and organized.
Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, there were no deficiencies cited during this visit. Exit interview held and a copy of report was left.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
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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