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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700843
Report Date: 07/27/2022
Date Signed: 07/27/2022 01:28:31 PM


Document Has Been Signed on 07/27/2022 01:28 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
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:
95758
CAPACITY:6CENSUS: 3DATE:
07/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Angelita Dayoan - AdministratorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required 1 Year Annual Inspection visit. LPA was allowed entry into the home and is licensed for a capacity of 6 non-ambulatory. LPA met with Administrator and explained purpose of visit.

LPA and Administrator 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 110.5*F which is within the required range of 105-120*F. The temperature inside the facility measured on the facilities thermostat to be 75*F which is within the required range of 68-85*F. The facility has alarms on each exit.
LPA observed there were food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times.
The first aid kit was complete. 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 are locked and readily available for review.
A review of (3) facility resident records was conducted and have all required documents for Community Care Licensing (CCL). A review of (2) facility personnel records was conducted. All staff is fingerprint cleared and associated to the facility. All staff have current First Aid/CPR certifications on file. Facility is conducting initial and continuing training as required. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils.
Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, there were no deficiencies cited during this visit.
Exit interview was conducted with Administrator and a copy of this report was provided at facility
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022
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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