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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700831
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:14:19 PM


Document Has Been Signed on 09/19/2024 02:14 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:HONEST LIVINGFACILITY NUMBER:
342700831
ADMINISTRATOR:TRAN, VINHFACILITY TYPE:
740
ADDRESS:9449 CHEVERNY WAYTELEPHONE:
(916) 425-8161
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 4DATE:
09/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lisa Saephan - LicenseeTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a case management visit on 9/19/2024. LPA met with Licensee Lisa Saephan and explained the purpose of today’s visit.

The purpose of today's visit is in response to deficiencies observed during an annual inspection visit on 9/19/24. LPA Truong observed an alteration to the building, a conversion of a single garage into a bedroom. Based on record review, it was learned that the facility has obtained a building permit since May of 2023. The construction was stated in April 2024 and finished in June 2024. Licensee advised that the bedroom is for live-in staff currently. It was learned that the facility has converted the single garage into a staff room for the live-in staff without notifying the Department. The licensee was advised to provide the Department with an updated facility sketch and plan of use of the bedroom.

Deficiencies were cited on the LIC 809-D pursuant to the California Code of Regulations, Title 22, and California Health and Safety Code.

An exit interview was conducted, a copy of this report, LIC 809-D and appeal rights were provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024
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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Document Has Been Signed on 09/19/2024 02:14 PM - It Cannot Be Edited

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: HONEST LIVING
FACILITY NUMBER: 342700831

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2024
Section Cited
CCR
87305(b)

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87305(b) Alterations to Existing Building or New Facilities: The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists.
This requirement is not met as evidence by:
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Licensee shall review Title 22 Regulations, Section 87305 and submit a written statement to LPA stating knowledge of, understanding of regulation by POC due date.
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Based on observations, the facility has made alteration to the single garage into a bedroom. The facility did not submit the plan to licensing, which poses a potential Health, Safety risk to residents in care.
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The Licensee shall provide LPA with building permits, plan of use of the bedroom and an updated facility sketch.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024
LIC809 (FAS) - (06/04)
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