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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003273
Report Date: 11/18/2021
Date Signed: 11/18/2021 10:33:21 AM

Document Has Been Signed on 11/18/2021 10:33 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:RITA GASPAR CARE HOMEFACILITY NUMBER:
347003273
ADMINISTRATOR:FRENI CHINGFACILITY TYPE:
735
ADDRESS:4309 ROSECREST WAYTELEPHONE:
(916) 857-1222
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY: 6CENSUS: 5DATE:
11/18/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Archie MascarinaTIME COMPLETED:
11:00 AM
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On 11/18/21 at 10:15am Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced Plan of Correction (POC) inspection at Rita Gaspar Care Home. LPA met with staff Archie Mascarina and together conducted a walk through of the facility to ensure no health or safety risks to residents in care.

LPA Gould walked though the facility to ensure that all lighting is all operational and the lighting is sufficient to meet the needs of the residents. LPA observed new lamps in the living room and family room that provides lighting in the areas that meet the regulations and provides adequate lighting to residents utilizing the space.

LPA also inspected the food supply of the facility and observed an adequate two day supply of perishable foods that meets the regulations. Facility has a refrigerator in the kitchen and an additional fridge and freezer located in the garage with additional food to meet the needs of residents and follow the facility menu.

LPA Gould has cleared the deficiency and a POC clearance letter will be generated and provided to the facility.

Per California Code of Regulations, Title 22 there were no deficiencies observed or cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2021
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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