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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700742
Report Date: 02/21/2024
Date Signed: 02/21/2024 02:00:02 PM

Document Has Been Signed on 02/21/2024 02:00 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:RODNICK CAREFACILITY NUMBER:
342700742
ADMINISTRATOR:HAMMETT, REBECCAFACILITY TYPE:
735
ADDRESS:9060 LORDSHIP WAYTELEPHONE:
(916) 316-6213
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 4DATE:
02/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:33 AM
MET WITH:Rebecca HammettTIME COMPLETED:
02:15 PM
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On 2/21/24, at 11:33am, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit, with the use of the CARE Inspection Tool. LPA initially met with staff on duty and explained the purpose of today’s visit. The facility administrator, Rebecca Hammett was notified of this visit and arrived shortly after. The facility is currently licensed to serve 4 developmentally disabled individuals in which 1 may be non-ambulatory. Present during this visit, there were no clients with 1 staff on duty.

At 11:40am, LPA and staff on duty inspected the facility’s physical plant including but not limited to the kitchen, dining room, clients bedrooms, bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. The facility is a one-story structure located in a residential neighborhood. There were no bodies of water on the premises. Outside of the facility was observe to be cleaned and clear of obstructions. Additionally, LPA observed outdoor furniture for clients' use and covered area for outdoor activities. Entrance, exits and hallways were observed to be clear of obstructions. LPA observed 4 client bedrooms and 2 bathrooms. Bathrooms were operational and adequately supplied including with grab bars and non-skid flooring. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the client's personal belongings. Bed linens, comforters, and bath towels were adequately stocked during the visit.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were locked and not accessible to clients in care. The kitchen was inspected, and sufficient 2-day perishable and 7-day non-perishable food was maintained adequately. Room temperature was maintained in the facility at 68 degrees F. Water temperature in one of the bathroom was measured at 108 degrees F. Fire extinguisher was serviced on 8/11/23. Smoke detectors and carbon monoxide were observed during this visit.

{Con't to LIC809-C}

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RODNICK CARE
FACILITY NUMBER: 342700742
VISIT DATE: 02/21/2024
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{Con't from LIC809}

Medication storage area was observed to be locked and inaccessible to clients in care. Medications were reviewed for accuracy. First aid kit was observed to have adequate supplies and accessible to staff. The facility maintains for each clients Centrally Stored Medication, Destruction Record and PRN Log. LPA observed the facility's infection control practices. LPA observed supplies of Personal Protective Equipment (PPE) in the laundry room. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility to have a sufficient equipment and supplies to meet activity program needs of residents in care.

During this inspection, LPA conducted an audit of facility files, 4 clients files, and 4 staff files for regulatory compliance. All staff noted on LIC 500 have criminal background clearances and associated to this facility. 4 out of 4 clients files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. 4 out of 4 staff files reviewed contained all required contents including health screening, TB results, current first aid/CPR, and initial and ongoing required trainings. The facility is current on annual license fees. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts monthly fire drills and semiannual disaster drills.

LPA observed the following forms that were updated: LIC 308, LIC 500, liability insurance certificate and surety bond. LPA requested copies of these to be emailed to LPA.

Per California Code of Regulations (Title 22, Division 6, Chapter 8), no deficiencies were observed during this visit. An exit interview was held with Rebecca Hammett, Administrator, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC809 (FAS) - (06/04)
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