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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700691
Report Date: 01/12/2023
Date Signed: 01/12/2023 11:50:33 AM


Document Has Been Signed on 01/12/2023 11:50 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:PADUA CARE HOMEFACILITY NUMBER:
342700691
ADMINISTRATOR:DAYOAN, ANGELITAFACILITY TYPE:
740
ADDRESS:8708 THETFORD COURTTELEPHONE:
(916) 218-8556
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 5DATE:
01/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:Angelita DayoanTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct the annual required visit. LPA met with facility staff, and explained the purpose of the visit. Administrator Angelita arrived to the facility shortly after visit.

LPA toured the facility with Administrator Angelita. LPA measured the hot water at 118.0*F. The facility room temperature was observed to be 73*F, which is within the required range. The facility was observed to have nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. An emergency supply of food was also observed to be enough for one month for all residents and staff. Medications, sharps, and toxic supplies were observed to be locked and inaccessible to residents. A pull alarm system and fire extinguishers were observed to be in compliance and working condition. The facility common areas were clean, organized, and free from debris. No emergency exits were obstructed. All rooms had required furniture and furnishings. A first aid kit was observed to have all necessary items.

LPA interacted with residents and staff during the visit. Residents were observed doing ADLs, watching television, enjoying a snack/drink, reading a book, and taking a nap.

LPA obtained the following documentation: Liability Insurance, Emergency Disaster Plan, Resident Roster, LIC 500, LIC 308

Per California Code of Regulations (CCR), Title 22, no deficiencies were observed. An exit interview was held, and a copy of the report was given.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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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