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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701314
Report Date: 01/19/2024
Date Signed: 01/19/2024 12:07:58 PM


Document Has Been Signed on 01/19/2024 12:07 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:PRIMECARE SENIOR SERVICES LLCFACILITY NUMBER:
342701314
ADMINISTRATOR:KAGECHE, FRANCIS MFACILITY TYPE:
740
ADDRESS:3931 RILEY ANTON WAYTELEPHONE:
(916) 294-7388
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY:4CENSUS: 0DATE:
01/19/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Francis KagecheTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Michael Bilger conducted an announced pre-licensing visit to this facility on 1/19/2024 at 9:55am and was met by the Applicant, Francis Kageche. Brief interview was conducted with the Applicant. It was learned that this facility will be licensed as a residential care facility for the elderly (RCFE) to serve up to 4 non-ambulatory clients . This Applicant is also seeking vendorization from Alta California Regional Center to accept and retain Level 4F clients. There were no clients present during today's pre-licensing visit. Tour of the facility was conducted. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. LPA observed no obstruction of emergency exits. Exit signs in place as appropriate. Fire extinguisher in place at kitchen area and garage, and fully charged. Facility map indicating emergency exits posted in appropriate locations. All appropriate posting were observed.
Kitchen area was toured. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. Food supply is adequate at this time. Medication cabinet, located in the laundry area was observed to be locked. First aid kit was observed to be present and contained all required components at this time.
A tour of the resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time.
A tour of the resident bathrooms was conducted. Hot water temperatures are within the allowed range of 105-120 degrees F. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time.

This facility has been found to be in compliance at this time. There were no deficiencies observed during today's Pre-licensing visit. Component III completed with applicant during visit. Exit Interview conducted with applicant Francis Kageche A copy of this report was left with the Applicant.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2024
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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