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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700489
Report Date: 04/04/2023
Date Signed: 04/04/2023 01:50:57 PM


Document Has Been Signed on 04/04/2023 01:50 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:PALMS COURT IFACILITY NUMBER:
342700489
ADMINISTRATOR:OGUNDWIN, ADEOLAFACILITY TYPE:
740
ADDRESS:6821 LINCOLN AVETELEPHONE:
(916) 993-8166
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 1DATE:
04/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Adeola OgundwinTIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPA) Kevin Mknelly and Sarah Benson arrived at the facility unannounced on 4/4/23 to conduct a Annual Inspection. LPA met with licensee and explained the purpose of the visit. Administrator was present for the inspection

LPA toured the interior and exterior of the facility together with licensee to ensure health and safety of resident in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. Part of the yard fence was damaged in recent storms and is scheduled to be replaced.

LPAs conducted a file review for 1 staff and 1 resident. Resident records needing update were noted.
Staff file was complete with the exception of training which are off site and will be provided.


No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023
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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