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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701096
Report Date: 05/26/2022
Date Signed: 05/26/2022 02:22:11 PM


Document Has Been Signed on 05/26/2022 02:22 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:SCARLETT CARE HOME, LLCFACILITY NUMBER:
342701096
ADMINISTRATOR:LOZANO, JOANNE MARIE M.FACILITY TYPE:
740
ADDRESS:3708 NORTH EDGE DRIVETELEPHONE:
(916) 977-3679
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 6DATE:
05/26/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Joanne LozanoTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Avelina Martinez arrived unannounced to conducted a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Avelina Martinez met with Joanne Lozano and explained the purpose of today's visit.

Facility has a fire clearance for 6 non-ambulatory residents. Administrator, Joanne Lozano, will be the Administrator of this facility. The facility administrator’s certificate is current and expires July 25, 2023.      .

LPA Martinez inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen.

LPA Martinez observed sufficient seven day non-perishable and two day perishable food supplies. Thermostat observed at (73) degrees Fahrenheit. The facility is sanitary and all common areas are furnished. The resident rooms are sanitary and furnished. The facility conducts disinfection cleaning daily. The facility has Covid-19 posting throughout the facility, and has one main entry screening point. The facility has a PPE supply. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 08/30/2021 The exterior of the facility is clear of debris, and the facility has an emergency exit gate. The facility has a shaded patio with furniture. LPA Martinez reviewed 1 employee file and 1 resident file. Both files were up to date.



The applicant has passed the pre-licensing component of the application process. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. The Administrator has previously completed component 3, as a result, this portion has been waved.

An exit Interview was conducted, and a copy of this report was given to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022
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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