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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701176
Report Date: 07/13/2022
Date Signed: 07/13/2022 02:28:01 PM

Document Has Been Signed on 07/13/2022 02:28 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:CISTERS LOVING CARE HOME IIFACILITY NUMBER:
342701176
ADMINISTRATOR:CISTER, ROCHELLEFACILITY TYPE:
735
ADDRESS:5316 NECTAR CIRCLETELEPHONE:
(916) 479-3508
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 4CENSUS: 0DATE:
07/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Rochelle Cister, ApplicantTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Tung Truong conducted an announced pre-licensing inspection visit on 7/13/2022 at 1:30 PM. LPA met with Rochelle Cister, Applicant/Administrator and explained the purpose of today’s visit. The facility will be licensed for a capacity of 4, 1 non-ambulatory client and 3 ambulatory clients.

Administrator Rochelle Cister holds a current certificate # 6050060735 which will expire on 11/26/2022. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to clients.

LPA observed the facility common areas were clean and furnished. There were no clients in care at this time. The temperature inside the facility was observed to be at 78*F which is within the required range of 68-85*F. The hot water temperature was measured and is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility were in good repair. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit was up to date. LPA observed no obstruction of emergency exits inside or outside of facility.

Based on a review of this facility during this pre-licensing visit, it was determined that this facility was found to be in compliance at this time. Administrator Rochelle Cister has completed Component III before and therefore waive this requirement. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed.



Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed or cited. Exit interview held, copy of report given.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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