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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002830
Report Date: 05/08/2024
Date Signed: 05/08/2024 02:58:54 PM

Document Has Been Signed on 05/08/2024 02:58 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:REM CALIFORNIA, LLC - SAN JUANFACILITY NUMBER:
345002830
ADMINISTRATOR/
DIRECTOR:		TANNENBAUM, ROSEFACILITY TYPE:
735
ADDRESS:3831 SAN JUAN AVENUETELEPHONE:
(916) 550-0668
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 4CENSUS: 4DATE:
05/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Rolito IntalTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Wednesday May 8, 2024 to conduct the unannounced annual inspection.

LPA met with Administrator Rolito and explained the purpose of the visit.

During today's visit, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed 4 client files and 3 staff files. All client contained the required paperwork. All staff files contained the required paperwork and training.

LPA and Rolito toured the facility together to ensure the health and safety of clients in care. Areas toured included bedrooms, bathrooms, laundry room, garage, kitchen, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. Facility was current on fire drills. First Aid kit was fully stocked. Chemicals were kept locked and inaccessible to clients.

LPA obtained an updated copy of LIC500. Additionally, LPA obtained documents to associate Rolito as Administrator.

No deficiencies cited. Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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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