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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003936
Report Date: 08/19/2024
Date Signed: 08/19/2024 04:14:54 PM


Document Has Been Signed on 08/19/2024 04:14 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:TENDER HOME SENIOR CAREFACILITY NUMBER:
347003936
ADMINISTRATOR:MARINOVA, VALENTINAFACILITY TYPE:
740
ADDRESS:3499 PONZI COURTTELEPHONE:
(916) 851-1888
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:6CENSUS: 5DATE:
08/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Valentina MarinovaTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual required inspection. LPA Valerio met with facility staff, and explained the purpose of the visit. LPA was later met Administrator Valentina Marinova.

LPA Valerio and Administrator Valentina toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed common areas to be clean, organized, and free from debris. Resident bedrooms were fully furnished, free from odors, and without obstructions of emergency exit door ways. Resident bathrooms were observed to be clean and fully stocked with hygiene supplies. Residents were observed sitting in the living room, in their bedroom, eating lunch while watching television, and having a family visit. Staff was observed folding resident laundry, preparing meals for residents, cleaning the facility, and assisting with resident ADLs. Cleaning supplies, sharps, and medications were locked and inaccessible to residents in care. The facility was observed to have a minimum of seven days of non-perishable food items and two days of perishable food items. An emergency supply of food was observed. The facility exterior area was observed. LPA observed multiple areas for outside seating and emergency exits to be clear. Facility fire extinguisher, fire pull alarm system, and air conditioning were observed to be in compliance and in working condition. Hot water was measured to deliver hot water at 105.3 degrees, which is within the required range of 105 - 120 degrees F.

LPA Valerio reviewed two (2) staff files and three (3) resident files. One out of three resident files were observed out of compliance due to resident appraisals not being updated within the last 12 months. Technical Assistance was provided. Licensee to update files for all residents.

LPA Valerio requested the following annual documentation be sent: LIC 500, LIC 308, LIC 610E, Copy of Liability Insurance

Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited on today's visit. An exit interview was held, and a copy of this report was provided to Administrator Valentina.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2024
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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