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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700843
Report Date: 08/18/2020
Date Signed: 08/18/2020 04:11:43 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:PADUA ASSISTED LIVING 2FACILITY NUMBER:
342700843
ADMINISTRATOR:DAYOAN, ANGELITAFACILITY TYPE:
740
ADDRESS:2929 BABSON DRIVETELEPHONE:
(916) 478-2915
CITY:ELK GROVESTATE: CAZIP CODE:
95658
CAPACITY:6CENSUS: 3DATE:
08/18/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Angelita DayoanTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Victoria Brown contacted the Applicant via telephone to commence an unannounced Pre-Licensing Tele-Inspection visit on 8/18/20 at 1:30pm due to COVID-19 and pre-cautionary measures.

LPA was allowed entry into the home via Facetime that will be licensed for a capacity of 6 non-ambulatory. LPA met with Angelita Dayoan, Applicant who assisted with today’s visit. This visit is due to a Change in Ownership. There are 3 residents receiving care and supervision during this visit.

LPA and Angelita Dayoan toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed the residents and staff social distancing with masks during this visit.
LPA observed the kitchen area, dining area, bedrooms, bathrooms, storage areas, and laundry room. LPA observed knives/sharps area to be locked. LPA observed required furniture, and lighting throughout the facility.
The hot water temperature was measured using the facilities thermometer to be 106.8*F which is within the required range of 105-120*F. The temperature inside the facility measured on the facilities thermostat to be 78*F which is within the required range of 68-85*F. The facility has alarms on each exit.
LPA observed area where food supplies are kept such as non-perishables for a minimum of one week and perishable foods for a minimum of two days which shall be maintained on the premises.
The first aid kit included supplies such as sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed centrally stored medications area to be locked.
LPA observed the fire extinguisher(s), smoke and carbon monoxide detector(s) in the home. Facility also has central heating and air. LPA observed the area where the staff and resident files will be locked and readily available for review.

Component III conducted - Licensure pending.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit. An exit interview was conducted with Applicant Angelita Dayoan via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2020
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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