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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700193
Report Date: 06/07/2022
Date Signed: 06/08/2022 07:43:23 AM

Document Has Been Signed on 06/08/2022 07:43 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:FRUITRIDGE HOMEFACILITY NUMBER:
342700193
ADMINISTRATOR:FINNEY, DIANAFACILITY TYPE:
735
ADDRESS:2780 33RD AVETELEPHONE:
(916) 395-1856
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY: 6CENSUS: 6DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Elvie Mein, House ManagerTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) R. Campbell and R. Wallace made an unannounced visit to this care home to conduct an Annual Required inspection.

LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are three bedrooms and three bathrooms for residents, in addition LPAs observed a staff room. LPAs observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained and the hot water temperature was observed to be 118.2 degrees F. in the second bathroom located in the middle hallway.

LPAs checked the kitchen area for the ability to prepare and store food. LPAs observed there to be a sufficient amount of perishable and non- perishable food supplies on hand. LPAs observed knives and toxins to be locked away and inaccessible to clients. LPAs observed the backyard and perimeter of the care home to be free of clutter and debris, and there appeared to be no immediate safety hazards to the residents in care. Fire extinguishers last serviced on 02/01/2022 and first aid kit are maintained and ready for emergency use. Care home also conducts monthly fire/disaster drills.

LPAs checked medication storage and found medication to be locked away and inaccessible to clients. Two resident records were reviewed for completeness and accuracy and LPAs observed all required documentation to be in place. . Administrator holds current certification #6036767735 and expires on 9/18/2023.

As a result of today's inspection, no deficiencies are being cited during this visit.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2022
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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