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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001904
Report Date: 05/26/2021
Date Signed: 05/26/2021 03:28:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:LP NUNEZ CARE FACILITYFACILITY NUMBER:
347001904
ADMINISTRATOR:NUNEZ, LEONIL D.FACILITY TYPE:
740
ADDRESS:8000 35TH AVENUETELEPHONE:
(916) 386-8332
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY:4CENSUS: 3DATE:
05/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Licensee Lionel Nunez Jr.TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Anthony Tuck and Licensing Program Manager LPM Czarrina Camilon-Lee Island arrived to conduct an unannounced annual/random inspection on 05/26/2021. LPA met with Licensee Lionel Nunez Jr and explained the purpose of the visit. Lionel Nunez is the Administrator and holds certificate #6053124725 that expires on 02/26/2022.

This facility is a single story building licensed to serve four (4) ambulatory residents. LPA toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 105.8 degrees Fahrenheit in kitchen sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke detectors are in compliance with fire safety. Fire extinguisher last serviced October of 2020.

LPA observed centrally stored medications and toxins was kept locked and inaccessible to clients. LPA reviewed medication cabinet that was securely locked and sharp knives also securely locked. All disinfectants were also secured and inaccessible to clients. LPA reviewed staff associations to the facility. First aid kit was checked and is complete.
The following forms need updating and submitted to CCLD by 05/28/2021:
LIC 610E
copy of Administrator certificate
No deficiencies were found during todays visit.

Exit interview held with Staff Edna Dimingo and a copy of report given at the conclusion of the visit.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (209) 242-5200
LICENSING EVALUATOR NAME: Anthony TuckTELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
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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