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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002830
Report Date: 06/09/2023
Date Signed: 06/09/2023 03:31:31 PM

Document Has Been Signed on 06/09/2023 03:31 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 NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:REM CALIFORNIA, LLC - SAN JUANFACILITY NUMBER:
345002830
ADMINISTRATOR:DOVE-MOSLEY, TAUKOSHIUAFACILITY TYPE:
735
ADDRESS:3831 SAN JUAN AVENUETELEPHONE:
(916) 550-0668
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 4CENSUS: 4DATE:
06/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Rose TannenbaumTIME COMPLETED:
03:45 PM
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On 6/9/23, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit s and met with Administrator, Rose Tannenbaum .

On 5/17/23, the department conducted an annual inspection where it was found that 2 clients in care are non-ambulatory. This put the facility out of compliance with their fire clearance. Citation was issued on 5/24/23. Subsequently, a fire inspection was conducted and advice provided for building modifications needed for a new clearance.

Building modifications are in process.

Licensee will update their emergency plan to include specific procedures for assistance to non-ambulatory clients in the event of an emergency evacuation of the home. The updated plan will be submitted by end of business on Monday, 6/12/23.

As a result of today’s inspection, no deficiencies were noted.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2023
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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