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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700831
Report Date: 08/04/2021
Date Signed: 08/04/2021 02:48:09 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) 425-8161
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 2DATE:
08/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Vinh TranTIME COMPLETED:
02:50 PM
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On August 4, 2021 at 1:22pm Licensing Program Analyst (LPA) Chris Hopkins arrived at Honest Living for the purpose of conducting an unannounced required 1 year annual inspection. LPA met with Administrator, Vinh Tran and Licensee Lisa Saephan showed up at a later time and conducted a tour of the home.

LPA and Licensee evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility.

LPA measured the water temperature, temperature measured at 110 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven-day non-perishable and two-day perishable food supplies. Fire extinguishers and smoke/carbon monoxide detectors are current and in compliance with fire safety. LPA observed centrally stored medications secure from residents. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point and has implemented screening and sign in procedures at the front door area. LPA observed the facility to have hand washing signs, COVID - 19 informational signage, and social distancing signs posted throughout the facility. The facility has a designated infection control lead individual. Common touch surfaces are cleaned regularly throughout the day.

LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 610E Emergency Disaster Plan, Administrator Certificate and Liability Insurance.

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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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