<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700579
Report Date: 10/02/2023
Date Signed: 10/02/2023 10:40:56 AM


Document Has Been Signed on 10/02/2023 10:40 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:CHATEAU AT RIVER'S EDGE, THEFACILITY NUMBER:
342700579
ADMINISTRATOR:MUNDAY, PAMELAFACILITY TYPE:
740
ADDRESS:641 FEATURE DRTELEPHONE:
(916) 921-1970
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:143CENSUS: 86DATE:
10/02/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH: Elena CuevasTIME COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual continuation inspection on 10/02/2023 at 8:00 AM. LPA Martinez met with Elena Cuevas and stated the purpose of today’s visit. LPA Martinez inspected the physical plant of the facility to ensure compliance with Title 22 regulations.

The facility is licensed for 26 ambulatory residents and 116 non-ambulatory residents, which 10 may be bedridden. In addition, the facility has an approved hospice waiver for 15. There are currently 86 residents who reside at this facility.

LPA Martinez toured the facility with Elena Cuevas on 10/01/2023 at 9:30 AM.

During today's visit, LPA Martinez toured the memory care unit, and the memory care unit census is 9. LPA Martinez reviewed the fire inspection report with Elena Cuevas. Elena Cuevas and LPA Martinez toured the exterior of building and fire sprinkler system. During the tour, LPA Martinez and Elena Cuevas visited the pond area. Elena Cuevas reported the pond was three feet deep. During 09/28/2023 initial annual visit, LPA Martinez reviewed medication administration records, staff files, resident files, toured the facility, inspected the kitchen, and inspected fire extinguisher tags. 09/28/2023 deficiencies can be found on the annual 09/28/2023 809 report. In addition, LPA Martinez reviewed administrator change request documentation. The Department will continue to follow up with process of Elena's administrator certificate renewal request.

As result of today's visit, there were no deficiencies cited. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1