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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700333
Report Date: 06/12/2024
Date Signed: 06/12/2024 01:40:51 PM


Document Has Been Signed on 06/12/2024 01:40 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: 103DATE:
06/12/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Parveen Saroay, AdministratorTIME COMPLETED:
12:15 PM
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On 06/12/2024, a non-compliance conference was conducted. The purpose of this conference meeting was to address non-compliance at the facility after being issued 10 Type A citations and 7 substantiated complaint allegations since May 2023. Present in the meeting was CCLD staff, including Regional Manager Alycia Berryman, Licensing Program Managers Maribeth Senty and Anthony Perez, Licensing Program Analysts Angela Hood and Michael Hood, and facility staff, including the Licensee Kirt Hamburg, Administrator Parveen Saroay, and Resident Care Director Amardip Singh. The conference process was explained during this meeting.

Issues discussed during this meeting were:
· An overview of non-compliance at the facility regarding 10 Type A citations, 7 substantiated complaint allegations, and multiple civil penalties since May 2023
· Repeat violations regarding medication errors - medication management

The facility has stated that they will do the following to achieve continued and substantial compliance:
· Conduct regular audits of medications and care notes
· Ensure staffing is sufficient to meet the needs of the residents in care
· Ensure documentation is current and accurate to reflect the conditions of the residents in care
· Ensure communication with all necessary parties regarding changes in the residents occurs

Facility was notified that the Department may increase monitoring at the facility and the completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager.

Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024
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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