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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700651
Report Date: 02/25/2022
Date Signed: 02/25/2022 12:14:10 PM


Document Has Been Signed on 02/25/2022 12:14 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:PADUA ASSISTED LIVINGFACILITY NUMBER:
342700651
ADMINISTRATOR:PADUA, NICHOLASFACILITY TYPE:
740
ADDRESS:7019 MCGILL COURTTELEPHONE:
(916) 647-3483
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:6CENSUS: 5DATE:
02/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rosario Reyes TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a case management visit. LPA Valerio explained the purpose of the visit and was met by facility staff Rosario Reyes. Staff confirmed zero residents and zero staff have displayed any signs or symptoms of COVID-19 in the last 10 days.

LPA Valerio interviewed 3 staff members on shift. All staff members stated they are not aware of any change of ownership, no notices were given to residents, and the licensee are still Angelita Dayoan and Nicholas Padua. LPA interacted with 2 residents during the visit. The 2 residents expressed having a good day. There is 1 resident on hospice. 1 resident that left on an outing was given a mask and care for prior to leaving the facility.

LPA toured the facility to ensure the health and safety of residents and compliance of Title 22 regulations. No healthy or safety concerns. LPA observed 5 residents in the facility. Staff was observed to be cooking lunch. All resident rooms were clean and free from debris. LPA observed the liability insurance and administrator certificate to be active and not expired. LPA Valerio observed present staff members to be fingerprint cleared.

Based on observations and interviews, no deficiencies were observed. Exit interview held and a report was given to facility staff.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2022
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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