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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700333
Report Date: 08/17/2023
Date Signed: 08/17/2023 03:30:39 PM


Document Has Been Signed on 08/17/2023 03:30 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:FAIR OAKS ESTATES INCFACILITY NUMBER:
342700333
ADMINISTRATOR:SAROAY, PARVEENFACILITY TYPE:
740
ADDRESS:8845 FAIR OAKS BLVDTELEPHONE:
(916) 944-2077
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:106CENSUS: 100DATE:
08/17/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Parveen Saroay, Executive DirectorTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Angela Hood arrived at the facility and met with Executive Director, Parveen Saroay, to follow-up on a plan of correction made to the facility on 8/10/2023 to be corrected by POC visit.

During today's visit, LPA obtained a copy of facility's plan to ensure all corrections are made. A deep cleaning of the kitchen area will be conducted on 8/18/2023 after 6pm. The facility has hired a pest control company who will provide services the week of 8/20/2023. A follow-up treatment will be conducted as well.

The facility conducted a stand up meeting with staff regarding facility's plan regarding the deep cleaning of kitchen area as well as the pest control services. Staff were also informed about a training that will be conducted regarding food storage, disposal, and monitoring procedure to ensure expired and contaminated foods are discarded. A formal training will be conducted by 8/23/2023. A written plan is being created and will be submitted to CCL by 8/21/2023.

POC was cleared during today's visit. No additional deficiencies were issued during visit.

Exit interview was conducted with Executive Director and a copy of this report was provided to the facility. The signature of the Executive Director on this form acknowledges receipt of these documents.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela HoodTELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
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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