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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003040
Report Date: 08/17/2023
Date Signed: 08/17/2023 01:00:44 PM

Document Has Been Signed on 08/17/2023 01:00 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:LITO GASPAR'S CARE HOMEFACILITY NUMBER:
347003040
ADMINISTRATOR:GASPAR, EMERITOFACILITY TYPE:
735
ADDRESS:8360 NIGHTFALL WAYTELEPHONE:
(916) 395-3238
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 6CENSUS: 5DATE:
08/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Emerito Gaspar - AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Inspection Visit. LPA met with administrator and explained purpose of visit. Fire clearance was granted on for four ambulatory and two non-ambulatory clients. Administrator certificate is waiting for certificate.

LPA and administrator conducted a tour inside and outside the facility. LPA observed the back yard with secure fence and no pool or body of water observed. LPA observed all hallways and passageways to be free of clutter or hazards. LPA observed bedrooms and living areas to be adequately furnished. The temperature inside the facility was observed to be at 72*F which is within the required range of 68-85*F. The hot water temperature was measured at 110.9*F which is within the required range of 105-120*F. LPA observed a pull alarm system, fire extinguisher(s) last inspected on November 10, 2022, smoke and carbon monoxide detectors, and central heating and air in the facility. All Fire Exits are free of obstacles and last fire drill was completed on July 29, 2023. LPA observed two day perishables and seven day non-perishables.

LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items. LPA observed bathroom facilities to be functioning properly. Cleaning supplies and chemicals are stored in a locked cabinet. Medications and confidential paperwork will be stored in a locked cabinet. Night staff must be awake. Activity supplies available.
LPA reviewed three staff and two resident files. Resident emergency contact complete. LPA observed all staff and resident files complete. All staff have criminal record clearance and are associated to the facility.

LPA received the following updated documents for master file in CCL on today's date:
Designation of Facility Responsibility (LIC 308), Personnel Report (LIC 500), Emergency Disaster Plan (610-D), and Surety Bond.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited.

Exit interview held with administrator. A copy of report and LIC 811 (Confidential Names) left at facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
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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