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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700742
Report Date: 03/12/2025
Date Signed: 03/12/2025 11:46:03 AM

Document Has Been Signed on 03/12/2025 11:46 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:RODNICK CAREFACILITY NUMBER:
342700742
ADMINISTRATOR/
DIRECTOR:		HAMMETT, REBECCAFACILITY TYPE:
735
ADDRESS:9060 LORDSHIP WAYTELEPHONE:
(916) 316-6213
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 4DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Rebecca HammettTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 3/12/2025, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to conduct the required annual inspection visit. LPA met with Rebecca Hammett, Administrator (AD) and stated the purpose of this visit. Present during today's visit were one client in care with one staff on duty (AD). The other three clients were out in the community.

LPA and AD inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, and outside backyard. Facility is a one story home located in a residential neighborhood, with 4 bedrooms and 2 bathrooms. The facility serves adult residents with developmental/intellectual disabilities.

LPA observed room temperature at 70 degrees Fahrenheit. LPA observed sufficient furniture and lighting throughout the facility. LPA observed food supplies of at least 7-day non-perishable and 2-day perishable. LPA measured the hot water temperature in resident's bathroom at 105 degrees Fahrenheit which is within regulatory range. Refrigerator and freezer temperatures were within regulatory range.

Fire extinguishers last inspected on 9/10/2024. Smoke detectors and carbon monoxide detectors were observed and found to be in good working condition. LPA observed centrally stored medications are kept locked in the kitchen area and inaccessible to residents. First aid kit was checked and is complete. The facility conducts fire drills with residents on a monthly basis. Last fire drill was conducted on 2/17/25. Facility also conducts semi-annual disaster drill and last disaster drill was on 1/25/25.



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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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: 03/12/2025
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LPA reviewed two client files: Per review, 2 of 2 client contain updated Needs and Services Plan and Medical Assessments. LPA reviewed P&I records for 4 clients and found to be in compliance. LPA reviewed medication records for 2 clients in care and found to be in compliance at this time. .

LPA reviewed four staff files: Per review, 4 of 4 staff have background clearance/fingerprint cleared and associated to the facility. 4 of 4 staff have current 1st Aid/CPR certificate. LPA verified staff training for staff file reviews.

LPA requested copy of the following updated documents during this visit: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, Copy of Liability Insurance Certificate, and Copy of Surety Bond.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies cited during this visit.

Exit interview held with administrator. A copy of report was provided.















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

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC809 (FAS) - (06/04)
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