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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001880
Report Date: 01/08/2024
Date Signed: 01/08/2024 11:11:56 AM

Document Has Been Signed on 01/08/2024 11:11 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ED DAVID CARE HOME #2FACILITY NUMBER:
347001880
ADMINISTRATOR:MARINA DAVIDFACILITY TYPE:
735
ADDRESS:7200 LARCHMONT DRIVETELEPHONE:
(916) 331-4775
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 6CENSUS: 6DATE:
01/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Diamond Anderson TIME COMPLETED:
11:20 AM
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On 01/08/24, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct a required annual inspection. LPA met with administrator, Diamond Anderson and explained purpose of inspection. The facility is an ARF that is vendorized through Alta California Regional Center. There are (6) residents who reside at the home. At the time of today's visit, all residents were at day program.

LPA and Administrator toured the interior and exterior of the facility including the common areas, residents bedrooms, residents /staff bathrooms, staff room, kitchen, laundry area and outside area. LPA observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed all required postings, including House Rules and personal rights. Inside temperature was observed to be 69* F. Fire extinguisher was ready for emergency use. Facility conducts monthly fire and disaster drills, at different hours of the day. The facility has a large back yard area with seating. There are no pools/ponds. LPA observed locked toxins in the laundry area and locked medications in a separate cabinet. LPA observed sufficient 2+day perishable/7+day non-perishable food and sufficient PPE on hand. LPA observed paper towels, soap, sanitizer, trash cans and hand-washing posters in the bathroom. Water temperature measured 117* degree F in the kitchen which was in required range (105-120 degree F) . Smoke/monoxide alarms were in working order. Games/activities observed on site.

LPA reviewed (2) residents files and (2) staff files and found the required documentation on file, including staff training. LPA reviewed medications for (2) residents and found no errors.

No deficiencies were observed or cited today. Exit interview conducted.
A copy of this report was printed and given to Administrator.


SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2024
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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