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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920011
Report Date: 04/30/2024
Date Signed: 04/30/2024 12:43:39 PM

Document Has Been Signed on 04/30/2024 12:43 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:JVC LLCFACILITY NUMBER:
345920011
ADMINISTRATOR/
DIRECTOR:		CHANG, CHE CHIANGFACILITY TYPE:
740
ADDRESS:7845 DOMINION WAYTELEPHONE:
(530) 949-5259
CITY:ELVERTASTATE: CAZIP CODE:
95626
CAPACITY: 6CENSUS: 4DATE:
04/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:34 AM
MET WITH:Maria Morhatt admistratorrTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On April 30, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a required Annual Inspection. LPA met with Maria Mohatt and explained the reason for the visit. The facility has not had anyone with Covid-19 thus far.

Computer issue kept LPA and Maria from completing the inspection tool questionnaire.

Administrator's certificate expires 10/1/2025. The temperature of the facility was 71 degrees F. The facility has 5 bedrooms and 4 bathrooms.

LPA toured the facility inside and out. The inside of the facility was observed to be in good condition and repair. LPA observed a table in the dining area. Plates and utensils were observed to be in place. Knives are observed to be locked in the kitchen. Dishwasher, stove, refrigerator, and microwave all present and working. This facility has a fire clearance. The facility also has a fully charged fire extinguisher and functioning smoke alarms/carbon monoxide detector and all exit doors have sound alarms. Food storage was adequate for two day perishables and 7 day non-perishable.

Bedrooms had all required furniture. Bathrooms were observed to be in good repair. Adequate linens such as sheets, blankets, etc. were observed. Cleaning supplies and toxins were found to be locked. Medications will be locked. Water temperature was measured at 105 F which meets the 105 F - 120F.

Per California Code of Regulations, Title 22, no citations were issued.



An exit interview was conducted and a copy of this report was given to Maria.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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