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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002829
Report Date: 12/19/2024
Date Signed: 12/19/2024 11:03:29 AM

Document Has Been Signed on 12/19/2024 11:03 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:VILLA LINDAFACILITY NUMBER:
347002829
ADMINISTRATOR/
DIRECTOR:		BACHIS, GABRIELFACILITY TYPE:
740
ADDRESS:6501 LINDA WAYTELEPHONE:
(916) 217-2056
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
12/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Gabriel BachisTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 12/19/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection, utilizing the CARE tool. LPA met with Administrator and explained the purpose of the visit.

Today's census is six residents in care with one resident on hospice services. Facility is currently licensed for six non-ambulatory, hospice waiver of three.

During today's visit, LPA and Administrator conducted a tour of the facility to ensure the health and safety of residents in care. Areas toured included but not limited to: six residents bedrooms, kitchen, caregiver room, bathrooms, and the common areas. LPA observed facility to be at a comfortable at 76*. LPA observed facility to have adequate food supply of two days of perishable and seven days of non perishable foods. LPA observed residents room to be free of sharps, toxins and medications. LPA observed the facility to be sanitary with no malodor.

LPA conducted a file review of five residents records and three personnel records. LPA observed facility to have documentation of staff training. LPA observed Emergency Disaster Plan present, but not updated. LPA provided Administrator a copy of 9-page LIC 610E. Liability insurance reviewed, and a photo was taken of the policy.

LPA is requesting proof of State Marshal seal tag to be emailed to LPA by Monday December 23, 2024.

As a result of today's visit, no deficiencies cited.

Exit interview conducted and a copy of the report was provided.
Anthony PerezTELEPHONE: (323) 485-4915
Cassie YangTELEPHONE: (916) 201-1928
DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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