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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700487
Report Date: 03/13/2024
Date Signed: 03/13/2024 11:03:16 AM


Document Has Been Signed on 03/13/2024 11:03 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:A HEARTY CARE HOME IIFACILITY NUMBER:
342700487
ADMINISTRATOR:CLARDY, MARIAFACILITY TYPE:
740
ADDRESS:5712 HERBAL WAYTELEPHONE:
(916) 664-3180
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:6CENSUS: 4DATE:
03/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Administrator- Maria ClardyTIME COMPLETED:
11:08 AM
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On 03/13/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a required 1- year annual inspection. LPA met with Caregivers and explained the purpose of the visit. LPA requested for staff to notify administrator of LPA's presence at the facility. Administrator, Maria Clardy later arrived at the facility.

LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to five (5) resident bedrooms, three (3) bathrooms, kitchen, common areas, and storage area. LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Toxins, cleaning supplies, knives and medications are locked and inaccessible to residents in care. Hot water temperature was measured at 119 degrees Fahrenheit at the kitchen sink, which is within the required range of 105 to 120 degrees. The temperature in the facility was 74 degrees. First aid kit was completed. LPA observed fire detectors and carbon monoxide detectors to be operable. LPA observed the fire extinguisher, located in kitchen, which was last inspected on 11/28/2023. LPA observed required Licensing posters posted throughout the facility.

LPA conducted a file review of two (2) personnel and three (3) residents records. All records have the required documents. LPA conducted one (1) staff interview.

No deficiencies are being cited during today's inspection.

Exit interview conducted and copy of the report was left at the facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
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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