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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002161
Report Date: 01/13/2025
Date Signed: 01/13/2025 03:24:17 PM

Document Has Been Signed on 01/13/2025 03:24 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:QUALITY ADULT CARE HOME COMPANYFACILITY NUMBER:
347002161
ADMINISTRATOR/
DIRECTOR:		HARRIS, VALERIE L.FACILITY TYPE:
735
ADDRESS:2 BOCK COURTTELEPHONE:
9169175360
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 6CENSUS: 6DATE:
01/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Raquel Harris TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 01/13/25.  LPA identified herself upon arrival, stated the purpose of the visit, and asked to speak with the Designated Facility Administrator (DFA).  LPA met with Designee, Raquel Harris, who also had her administrator's certificate. A brief interview followed. LPA requested the following documents:

LIC 500: Personnel Report
LIC 308: Designation of Administrative Responsibility
LIC 309: (for any LLC or Corp) if applicable
LIC 402: Surety Bond, if applicable
LIC 610E: Emergency Disaster Plan
Copy of Liability Insurance

LPA noted Designee's certificate # 6023431735 and it expired 12/16/24. The Licensee/Administrator, completed the necessary steps to renew their certification in September of 2024 and LPA requested proof of submission be emailed to Community Care Licensing at CCLASCPSacramento@dss.ca.gov.   

LPA noted Designee's certificate # 7027573735 and it expires on 04/11/2026.    

LPA compared the LIC 500 with the roster of staff obtained from Guardian to ensure that all staff had the appropriate background clearances to be working with the residents in care. All were in compliance at the time of this inspection.     

LPA inspected the 3 resident bedrooms. All had the required furniture, furnishings and lighting to be in compliance at the present time. All other common areas were also in compliance.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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: QUALITY ADULT CARE HOME COMPANY
FACILITY NUMBER: 347002161
VISIT DATE: 01/13/2025
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The LPA inspected the kitchen.  All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable.

The fire extinguisher was last serviced on 08/7/2024 by Fire Code Safety Equipment and was in compliance at the time of this inspection.

LPA inspected a total of 2 bathrooms.  Each contained soap, paper towels, and trash cans as required. Hot water was measured to ensure the temperature was between 105 and 120 degrees Fahrenheit in order to be in compliance.
 
The LPA observed medications were stored in a locked cabinet in the kitchen and inaccessible to residents in care. LPA reviewed storage, dosing, and destruction procedures. LPA provided technical assistance regarding the administration and logging of PRN medications.  A review of the First Aid kit by the LPA found it to be complete and in compliance.

The exterior of the building was inspected by the LPA.  There were no outbuildings or bodies of water present and the yard was completely fenced in.  There was also a sitting area for residents to enjoy in the backyard.

Both staff and resident files were made available for inspection during this visit. LPA reviewed 3 staff files: (S1-S3) and 3 resident files (R1-R3). All LIC 602s were current, all resident funds were accounted for, and all documents were in compliance at the time of this inspection.

According to the California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit. A copy of this report was provided and an exit interview conducted.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
LIC809 (FAS) - (06/04)
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