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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701299
Report Date: 11/05/2024
Date Signed: 11/05/2024 11:44:01 AM

Document Has Been Signed on 11/05/2024 11:44 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EVA LUIS RESIDENTIAL IIFACILITY NUMBER:
342701299
ADMINISTRATOR/
DIRECTOR:
MANIQUIZ, LUISFACILITY TYPE:
735
ADDRESS:8106 SAN REMO WAYTELEPHONE:
(916) 346-5602
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 4CENSUS: 3DATE:
11/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Luis ManiquizTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with facility staff, and explained the purpose of the visit. Facility staff contacted licensee and administrator via cell phone. LPA was later met by Administrator Luis Maniquiz.

LPA Valerio observed two (2) staff and one (1) resident present in the facility. The other two (2) residents were out for the day. Resident 1 (R1) was observed to be watching television and on their computer in their bedroom. Staff was observed to be cleaning and preparing the lunch for the day. LPA Valerio and facility staff toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed resident bedrooms to be clean, organized, with quality linens, and free from odors. Resident bathrooms were fully stocked with a skid matt, hand soap, paper towels, toilet paper, and hygiene supplies. Cleaning supplies and toxins were locked and inaccessible to residents in care. LPA observed common areas to be fully furnished and clean. There were no emergency exits observed to be obstructed. The medication cabinet was locked and was observed to have a first aid kit. Fire extinguisher was observed to be fully charged with an annual maintenance check. The facility was observed to meet the minimum food supply requirement. The exterior area was observed to have an area for outdoor visitation. The shed located in the backyard was observed to be utilized for storage. No health or safety concerns were observed.

LPA Valerio reviewed resident and staff files. Resident files were observed to be up to date with annual documentation. Staff files were observed to have annual required training. LPA Valerio requested the following annual documentation be sent to the Regional Office: LIC 500, LIC 308, LIC 610, and Copy of Surety Bond.

Per California Code of Regulations (CCR) - Title 22, no deficiencies were observed during today's visit. An exit interview was held, and a copy of the report was provided to Administrator Luis Maniquiz.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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