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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003327
Report Date: 11/16/2023
Date Signed: 11/16/2023 10:25:37 AM

Document Has Been Signed on 11/16/2023 10:25 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:AILEEN CANTOR-FERMO RESIDENTIAL CARE HOMEFACILITY NUMBER:
347003327
ADMINISTRATOR:FERMO-CANTOR, AILEENFACILITY TYPE:
735
ADDRESS:7016 22ND STREETTELEPHONE:
(916) 992-1904
CITY:RIO LINDASTATE: CAZIP CODE:
95673
CAPACITY: 6CENSUS: 6DATE:
11/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Aileen Fermo-CantorTIME COMPLETED:
10:30 AM
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On 11/16/23, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct a required annual inspection. LPA met with administrator, Aileen Fermo-Cantor and explained purpose of inspection. The facility is an ARF that is vendorized through Alta California Regional Center. There are (6) clients who reside at the home.

LPA and Administrator toured the interior and exterior of the facility including the common areas, client bedrooms,bathrooms, kitchen,staff room/office laundry area/garage. LPA observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various required posters throughout as well as other required postings, including House Rules and personal rights. Inside temperature was observed to be 74* degree F. Fire extinguisher last serviced 08/25/23 and ready for emergency use. Facility conducts monthly fire and disaster drills, at different hours of the day. The facility has a large back yard area with seating. There are no pools/ponds. LPA observed locked toxins in the laundry area and locked medications in a separate cabinet. LPA observed sufficient 2+day perishable/7+day non-perishable food and sufficient PPE on hand. LPA observed paper towels, soap, sanitizer, trash cans and hand-washing posters in the bathroom. Smoke/monoxide alarms were in working order. Games/activities observed on site.

LPA reviewed (2) client files and (2) staff files and found the required documentation on file, including staff training. LPA reviewed P&I funds and medications for (2) clients and found no errors.

LPA requested a copy of the LIC500, LIC610E and current liability insurance to be sent to the Department by 11/30/23.

No deficiencies were observed or cited today. Exit interview conducted. A copy of this report was printed and given to Administrator.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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