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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700843
Report Date: 08/10/2022
Date Signed: 08/11/2022 04:56:45 PM


Document Has Been Signed on 08/11/2022 04:56 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:
(279) 333-7621
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:6CENSUS: 4DATE:
08/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Angelita DayoanTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Albert Johnson arrived at the facility unannounced to open a ten day complaint yesterday. In addition to opening the ten day complaint, LPA conducted a case management inspection to check on the health, safety, and welfare of the clients in care. LPA met with Staff and explained the reason for the inspection.

LPA inspected the physical plant, inside and out. Fire extinguishers are in compliance. The hot water temperature is at 107 degrees F, which is within the required range.



Facility is maintained at a comfortable temperature. Residents in care appeared to be safe and have no imminent health/safety concerns observed. LPA inspected facility food supplies, which appeared to be adequate.

As a result of this inspection, No deficiencies were cited.

Exit interview conducted
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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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