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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003994
Report Date: 05/13/2024
Date Signed: 05/13/2024 02:13:18 PM

Document Has Been Signed on 05/13/2024 02:13 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AEGIS ASSISTED LIVING OF CARMICHAELFACILITY NUMBER:
347003994
ADMINISTRATOR/
DIRECTOR:		TRACY LEHNERFACILITY TYPE:
740
ADDRESS:4050 WALNUT AVETELEPHONE:
(916) 972-1313
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 90CENSUS: 72DATE:
05/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Tracy LehnerTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Monday May 13, 2024 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (7) and staff (7) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training. Facility is complaint with fire drills.

LPA and Maintenance Director toured the facility together to ensure the health and safety of residents in care. The areas toured included memory care apartments, memory care common areas, memory care courtyard, assisted living apartments, assisted living courtyard, lobby, kitchen, and dining room. LPA observed the facility's emergency food, water storage and PPE. LPA observed all required postings. LPA observed emergency evacuation chairs in each stairwell. First aid kit was fully stocked. In the areas toured, there were no health or safety violations observed.

LPA obtained a copy of the facility's current liability insurance, LIC500, and LIC610E.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the Administrator.
Maribeth Senty
Melissa Parks
DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2024
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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