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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700333
Report Date: 01/27/2023
Date Signed: 01/27/2023 05:17:44 PM


Document Has Been Signed on 01/27/2023 05:17 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:FAIR OAKS ESTATES INCFACILITY NUMBER:
342700333
ADMINISTRATOR:SINGH, GURSHAHBAZFACILITY TYPE:
740
ADDRESS:8845 FAIR OAKS BLVDTELEPHONE:
(916) 944-2077
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:106CENSUS: 103DATE:
01/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Kirt HamburgTIME COMPLETED:
05:15 PM
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On 1/27/23, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit- health and safety check. LPA spoke with the licensee and explained the reason for the visit.

Prior to initiating the visit, LPA completed required COVID-19 department protocols. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility.

On 1/26/23 the department was made aware of incidents regarding caregivers making unauthorized photos and videos posted on social media. The posting people have been removed from the schedule. Today the department is present because those who posted also organized a protest outside the entrance to the facility.

LPA observed that the facility is clean and staffed appropriate to the needs of the residents. While LPA Mknelly was present, residents were not adversely effected by the actions outside the facility grounds.

Licensee has made local law enforcement aware of the protest. LPA and licensee discussed their emergency preparedness were unauthorized visitors or personnel to enter the facility property.

As a result of today’s inspection, no deficiencies were noted. Report reviewed and copy provided.

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2023
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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