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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701181
Report Date: 09/27/2023
Date Signed: 09/27/2023 03:41:00 PM


Document Has Been Signed on 09/27/2023 03:41 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:SWEET MAGNOLIA PROCAREFACILITY NUMBER:
342701181
ADMINISTRATOR:ZEPEDA, VINCENTFACILITY TYPE:
740
ADDRESS:3920 PLAINSFIELD WAYTELEPHONE:
(916) 515-8482
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 6DATE:
09/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Vincent ZepedaTIME COMPLETED:
04:00 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) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 09/27/2023 at 2:30 PM. LPA Martinez met with Vincent Zepeda and stated the purpose of today’s visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate and expires on 05/22/2024. The facility is licensed for one ambulatory resident and five non-ambulatory residents, which one may be non-ambulatory in bedroom 5. There are currently 6 residents who reside at this facility. Moreover, the facility has an approved hospice waiver for four.

LPA Martinez toured the facility with Florence Campbell on 09/27/2023 at 3:00 PM.

The facility is sanitary and furnished, and the facility has a public telephone. The facility temperature measured at 75 degrees, and the water temperature measured at 105 degrees. The facility common areas, resident bedrooms, and resident bathrooms are furnished and sanitary. The facility smoke detectors, carbon detectors, and fire extinguishers are in good repair. The facility last fire drill was in July of 2023, and has a signal system. The facility has a first aid kit, and the emergency exit gate is in good repair. The facility has an adequate food supply, the kitchen is sanitary. The facility has a laundry room, which is in good repair. The facility has an area for activities. LPA Martinez reviewed three resident files and two employee files, which the facility files were maintained and complete. The facility has the required postings throughout the facility.

Based on this annual inspection, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time.

An exit interview was conducted, and a copy of this report was provided to facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
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