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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701430
Report Date: 09/26/2024
Date Signed: 09/26/2024 10:25:35 AM

Document Has Been Signed on 09/26/2024 10:25 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:E & G HOMEFACILITY NUMBER:
342701430
ADMINISTRATOR/
DIRECTOR:
ESTEPA, EZRA PAULOFACILITY TYPE:
735
ADDRESS:2309 ZINFANDEL DR.TELEPHONE:
(916) 221-2829
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 4CENSUS: 0DATE:
09/26/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Ezra Paulo EstepaTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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) Christina Valerio arrived announced to conduct the Pre-Licensing Visit and complete Component III. LPA Valerio met with Licensee/Administrator Ezra Paulo Estepa and Co-Licensee Georgina Manipud, and explained the purpose of the visit.

The facility has an approved fire clearance to service individuals aged 18 to 59 of age, approved for three (3) ambulatory residents, and approved for one (1) non-ambulatory resident, which may live in bedroom #4 only. LPA Valerio reviewed the facility's Emergency Disaster Plan and Infection Control Plan. No concerns were observed.

LPA and Licensee conducted a walk-through of the physical plant inside and out to ensure compliance with Title 22 regulations. LPA observed resident bedrooms to be fully furnished, clean, and organized. All bedroom doors were observed to have a lock. Resident bathrooms were observed to be stocked with hygiene supplies, a trash can, skid mats, and hand rails. The facility will obtain a hoyer lift. Common areas were fully furnished. LPA Valerio observed where medications, cleaning supplies, files, and sharps will be locked and inaccessible to residents. Exterior areas were observed to be furnished with areas for outside activities. No emergency exits were obstructed. Fire extinguisher, Carbon Monoxide detectors, and fire extinguisher were in working condition. All ramps were observed to be in compliance and sturdy.

Component III was conducted and completed with Licensees. Licensees/Administrator had no further questions.

Pre-Licensing is complete and this facility has no deficiencies. An exit interview was held, and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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