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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701325
Report Date: 03/12/2025
Date Signed: 03/12/2025 12:42:48 PM

Document Has Been Signed on 03/12/2025 12:42 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:CHERISHED CARE HOME LLCFACILITY NUMBER:
342701325
ADMINISTRATOR/
DIRECTOR:		OMATSEYE, TOGHARANROSE ADAFACILITY TYPE:
735
ADDRESS:9268 CHAROLAIS WAYTELEPHONE:
(916) 868-2112
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 3DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:TOGHARANROSE ADA OMATSEYETIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst(s) (LPA) Victoria Brown and Sommer Hayes arrived unannounced to conduct the Required - 1 Year visit on 3/12/25 at 9:00am. LPA met with TOGHARANROSE ADA OMATSEYE formerly Mary Omatseye and stated the purpose of the visit.

Administrator Certificate expires 10/29/2024. The most recent emergency drill was conducted 2/2/25.

The facility is licensed for a capacity of 4 Ambulatory residents. LPA conducted a review of 1 resident records and 1 staff records. LPA observed the Infection Control Plan during this visit.

LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables.

The temperature inside the facility was observed to be at 75*F which is within the required range of 68-85*F. The hot water temperature was measured at 114.7*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), pull alarm system, smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents.

The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies cited. Exit interview held, copy of report given
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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