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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001594
Report Date: 02/22/2024
Date Signed: 02/22/2024 12:08:42 PM


Document Has Been Signed on 02/22/2024 12:08 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:CHRIS BEST CARE FOR ELDERLYFACILITY NUMBER:
347001594
ADMINISTRATOR:VINLUAN, LITAFACILITY TYPE:
740
ADDRESS:8208 SUMMER FALLS CIRCLETELEPHONE:
(916) 682-3942
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:5CENSUS: 4DATE:
02/22/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Lita VinluanTIME COMPLETED:
12:16 PM
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On 02/22/2024 at 10:25 AM, Licensing Program Analyst (LPA) Pang Lee arrived at this facility unannounced to conduct a quarterly non-compliance visit. LPA was greeted by licensee Lita Vinluan and explained the purpose of the visit. The purpose of this visit is to conduct a quarterly visit in response to a Non-Compliance meeting that was conducted with the facility on 05/17/2023. The current census was 5 with 1 facility staff. LPA Lee did not observe care staff Christopher Vinluan present during today’s visit.

LPA Lee observed 4 residents in the home. Three residents were in the common area watching TV, “The Price Is Right” and another resident laying on the sofa sleeping. The residents appeared to be clean and comfortable. LPA Lee reviewed 4 out of 4 resident files and they were complete. LPA Lee reviewed 2 out of 2 staff files and they were also complete. LPA Lee reviewed 4 out of 4 resident Medication Administration Records (MAR) and it was complete.

A tour of the facility was conducted. It was observed that the facility thermometer measured at 74 degrees Fahrenheit. LPA Lee toured 4 resident bedrooms. All furniture and furnishing were observed to be in compliance at this time. LPA reviewed food supply to ensure that the facility had a 2-day perishable and 7-day nonperishable food supply and the facility had sufficient 2-day perishable and 7-day nonperishable food supply. LPA observed laundry room where it was observed that detergent, laundry room and all cleaning supplies were locked and made inaccessible at this time. Knives were observed to be locked and made inaccessible. A tour of the bathrooms was conducted, hot water temperature was taken to ensure regulatory requirements and was measured at 113.2. LPA Lee observed the bathroom had handrails and non-slip mat. A tour of the living room, garage, office, shed and all other areas intended for resident use was conducted. LPA Lee observed the fence to the left of the home was blown down and not in good repair. Licensee informed LPA Lee that she has called and filed a claim and an adjuster has been out to the home for estimate cost of repairs. Per licensee, cost of repair is pending. A technical assistance was given.
Continued LIC 809-C
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CHRIS BEST CARE FOR ELDERLY
FACILITY NUMBER: 347001594
VISIT DATE: 02/22/2024
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The first aid kit was checked and contained all of the required components. The carbon monoxide and fire alarm were in good repair. LPA Lee observed no emergency exits were obstructed.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC809 (FAS) - (06/04)
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