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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700024
Report Date: 09/21/2023
Date Signed: 09/21/2023 02:30:53 PM


Document Has Been Signed on 09/21/2023 02:30 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:
09/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Juan RamriezTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit to follow up on an incident report. LPA Moleski spoke with facility administrator Juan Ramirez over the phone and explained the purpose of the visit. Ramirez said staff member Kim Bennett could sign this report in his absence.

LPA Moleski spoke with Ramirez regarding incident reporting procedures. LPA Moleski interviewed a staff member (S1) and a resident (R1) regarding a fall suffered by R1 on 7/26/23. According to an incident report, the fall was unwitnessed. Both S1 and R1 said R1 was not seriously injured and did not need transport to the hospital.

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: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023
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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