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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701545
Report Date: 02/21/2025
Date Signed: 02/21/2025 11:19:58 AM

Document Has Been Signed on 02/21/2025 11:19 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:FARAI CARE CENTERFACILITY NUMBER:
342701545
ADMINISTRATOR/
DIRECTOR:		JACKSON, ANTONIOFACILITY TYPE:
735
ADDRESS:12415 WHEAT RIDGE DRIVETELEPHONE:
(661) 858-4069
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY: 4CENSUS: 0DATE:
02/21/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Antonio JacksonTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 02/21/25 Licensing Program Analyst (LPA) Kimberly Viarella made an announced visit to conduct a pre-licensing inspection. LPA identified herself upon arrival, stated the purpose of the visit and asked to speak with the Licensee. LPA met with the Designated Facility Administrator, Antonio Jackson and a brief interview followed.

LPA Inspected the kitchen, 4 bedrooms, staff room, 2 bathrooms, kitchen and common areas. All had the required furniture, furnishing and lighting to be in compliance at the time of this inspection. LPA inspected the exterior of the building and grounds and found that all windows and gutters were in good repair at the time of this inspection. There were no bodies of water present and no outbuildings. There was a shaded area with furniture for residents to enjoy.

LPA observed locked cabinets to keep medications inaccessible to future residents. All sharps were in a locked drawer and inaccessible to future residents. The hot water was measured and was 108.8 degrees Fahrenheit and in compliance at the time of this inspection.

There was adequate supply for 2 day perishable and 7 day non-perishable food items.

LPA observed sample of the daily schedule, sample menus, and a sample of activities for residents to enjoy.
The Emergency Plan and Resident Rights were also posted.

This facility is seeking a license for 3 ambulatory and 1 non-ambulatory residents. The facility did not pass inspection today because the ramps that were installed were not in compliance at the time of inspection. LPA will return at a later date to reinspect.

A copy of this report was provided. Exit interview.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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