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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700831
Report Date: 08/27/2020
Date Signed: 09/09/2020 03:50:12 PM

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:HONEST LIVINGFACILITY NUMBER:
342700831
ADMINISTRATOR:TRAN, VINHFACILITY TYPE:
740
ADDRESS:9449 CHEVERNY WAYTELEPHONE:
(916) 273-2407
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 0DATE:
08/27/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lisa Saephan & Vinh Tran, TIME COMPLETED:
04:35 PM
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LPAs Bruce Jacobs and Tung Truong conducted a tele-visit with applicants Lisa Saephan and Vinh Tran to conduct a Component III and Pre-Licensing inspection for this Residential Care Facility for the Elderly application. This facility has a fire clearance for 6 non-ambulatory residents.

LPAs conducted a visual tour of the facility inside and out. The inside of the facility was observed to be in good condition and repair. LPA observed a breakfast table in the kitchen with chairs. Food storage was adequate in the facility even though there are no residents at this time. Plates and utensils were observed to be in place. Dishwasher, stove, refrigerator, and microwave all present. The facility has a fully charged fire extinguisher dated 06/30/20 and functioning smoke alarms that are hardwired into the home. All exit doors have sound alarms. Hot water measured at 120.0 degrees.

Five resident bedrooms were observed. All bedrooms were observed to have furniture as required by Title 22 Regulations. Bathrooms were observed to be in good repair. Adequate linens such as sheets, blankets, etc. were observed. Storage and lighting was adequate in the home. Bathrooms had handrails and non-skid mats in the tub area.

Medications are to be locked up in a small medication room by the garage. Also locked in the kitchen are knives. Furnished living room was observed. Washer and dryer observed in place. Cleaning supplies and toxins are locked up. The garage area where hazardous items are stored was accessible to residents. During the inspection, applicants were able to install a key lock on the door making the area inaccessible. Home is in compliance and ready for licensure.

Exit interview and copy of report provided via email. Prelicensing report to be sent the application unit.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Bruce JacobsTELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020
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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