<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700194
Report Date: 02/13/2025
Date Signed: 02/13/2025 10:58:22 AM

Document Has Been Signed on 02/13/2025 10:58 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NORRIS SENIOR HOMEFACILITY NUMBER:
342700194
ADMINISTRATOR/
DIRECTOR:		VERA, NAZARINA DEFACILITY TYPE:
740
ADDRESS:4184 ENGLE ROADTELEPHONE:
(916) 571-5650
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
02/13/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:19 AM
MET WITH:Von VegaTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Holly Williams arrived at Norris Senior Home 342700194 for a plan of correction visit. LPA Williams stated the purpose of the visit. A brief interview was conducted with the facility staff person at this time. This LPA requested that the facility staff person go ahead and contact the facility licensee. Von Vega came to the house and met with LPA Williams.

The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 11/6/2024. This visit was to follow up on the shed in the back yard where the employee's are living. In an interview on 11/6/24, Von Vega said they would move the bed out and would try to get the shed permitted.

On 2/13/2025 in an interview, Vega stated that they were waiting for the fire clearance and that is the reason the shed has not been permitted. Vega informed LPA Williams to wait for the permit before the fire clearance which they did not get. LPA Williams informed Von Vega on 11/6/2024 that they could not have anyone sleeping out in the shed and the furniture would have to be moved out. When LPA arrived on 2/13/25 the furniture is still in the shed and employee's are still sleeping in the shed.
LPA Williams learned that a resident room is now used as a staff room. If the resident room will be used as a staff room a request will need to made to the Department. LPA Williams informed Vega that Vega is required to submit a new LIC200, new facility sketch, and a new fire clearance.

In an interview, Vega stated that they are waiting for a contractor to come out to turn the garage into a living room for staff. LPA Williams informed Vega that they have to write a letter to the Department about the new construction and it has to be labeled staff room on the facility sketch and obtain a permit and new fire clearance.
This facility is being cited per 22 CCR sections 87305(a).
An exit interview was held with Vega. Appeal rights and a copy of this report were left with Vega.
Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
Holly WilliamsTELEPHONE: 916-798-3161
DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/13/2025 10:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: NORRIS SENIOR HOME
FACILITY NUMBER: 342700194

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/15/2025
Section Cited
CCR
87305(a)

1
2
3
4
5
6
7
Prior to construction or alterations, all facilities shall obtain a building permit.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to provide a plan agreeing to not let anyone sleep in the shed and additional plans moving forward by POC due date. Holly.williams@dss.ca.gov
8
9
10
11
12
13
14
Based on observation, the licensee did not obtain a building permit and has staff living in shed in backyard which poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
Holly WilliamsTELEPHONE: 916-798-3161

DATE: 02/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2025

LIC809 (FAS) - (06/04)
Page: 2 of 2