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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004884
Report Date: 02/04/2025
Date Signed: 02/04/2025 02:53:47 PM

Document Has Been Signed on 02/04/2025 02:53 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:KAREN'S CASTLEFACILITY NUMBER:
347004884
ADMINISTRATOR/
DIRECTOR:
DAVIS-HARO, KARENFACILITY TYPE:
735
ADDRESS:8701 SANGRIA COURTTELEPHONE:
(916) 686-0766
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 3CENSUS: 3DATE:
02/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Karen Davis-HaroTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 2/4/2025, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to conduct an annual inspection. LPA met with Karen Davis-Haro, Administrator and explained the purpose of the visit. Upon arrival, all residents in care were out in the community.

This facility is a level 6 facility serving 3 residents in care. Facility is a one-story home located a residential neighborhood. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature in 2 resident bathroom sinks were measured at between 113 to 115 degrees Fahrenheit. Room temperature was at 69 degrees Fahrenheit. Fences and gates were observed to be in good repair.

Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications, sharp objects, poisonous substances and other dangerous items were observed to be locked and not accessible to residents in care. LPA conducted a review of money and medications for 2 of 3 residents and found to be accurate at this time. LPA reviewed resident and staff files, including criminal record clearances. All staff are fingerprint cleared and associated to the facility.

Facility conducts monthly drill and last drill was completed on 1/11/25. Fire extinguishers were observed to be in good repair and last serviced on 3/7/24. First aid kit was checked and is complete. LPA obtained copy of LIC500, LIC308, Liability Insurance Certificate, Surety Bond.

No deficiencies were cited. Exit interview conducted and copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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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