<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701159
Report Date: 09/06/2022
Date Signed: 09/06/2022 04:36:46 PM


Document Has Been Signed on 09/06/2022 04:36 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:BEATRICE SENIOR CAREFACILITY NUMBER:
342701159
ADMINISTRATOR:MITITI, BIANCAFACILITY TYPE:
740
ADDRESS:8901 MELODIC CTTELEPHONE:
(916) 270-3961
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 4DATE:
09/06/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Beatrice ClarkTIME COMPLETED:
04:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) R. Campbell arrived unannounced and conducted a Post Licensing inspection of the facility on this day, September 06, 20222 starting at 2:00 pm. LPA was greeted by one of the licensees, Beatrice Clark. LPA inspected the facility inside and out. Facility had 4 residents during the inspection. When LPAs came, one resident was at table eating and another resident was on the couch watching TV. Food supply was checked and LPAs observed at least 1-week and 2-day supply of nonperishable and perishable foods, respectively. Centrally stored medications were locked in a cabinet in the hall. Fire extinguishers were last inspected on March 01, 2022. First aid kit was complete with manual. Carbon monoxide and smoke detectors were interconnected and observed operational during visit. . PRN medications have written order from a physician. Toxic chemicals are stored in an outdoor locked cabinet..

Facility temperature is maintained at 75 degrees Fahrenheit. Hot water temperature measures 109 degrees Fahrenheit in one of the bathrooms. Each room is provided with working lights. There are grab bars for each residents' shower and toilet. Hallways and passages are free of obstruction. Hygiene supplies and toiletries are available.

Certified administrator is on site approximately 20 hours per week to oversee the business operation. The facility has trained staff to meet the residents’ needs. Staff who assist with activities of daily living and medication have the necessary basic and medication training.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: 916-206-6380
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1