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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700024
Report Date: 08/21/2023
Date Signed: 08/21/2023 02:53:21 PM


Document Has Been Signed on 08/21/2023 02:53 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
SACRAMENTO AC/SC, 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:
08/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Kim BennettTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit to follow up on issues identified during this facility's annual inspection. LPA Moleski spoke with administrator Christopher Faamausili over the phone and explained the purpose of the visit. Faamausili said staff member Kim Bennett could sign this report in his absence.

LPA Moleski inspected the facility's backyard area and medication closet. LPA Moleski observed no deficiencies in these areas.

No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Bennett.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2023
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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