<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005390
Report Date: 05/30/2024
Date Signed: 05/30/2024 12:07:49 PM

Document Has Been Signed on 05/30/2024 12:07 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:RAMIREZ CARE HOMEFACILITY NUMBER:
347005390
ADMINISTRATOR/
DIRECTOR:		RAMIREZ, ROWENAFACILITY TYPE:
735
ADDRESS:10575 HOME RANCH COURTTELEPHONE:
(916) 638-2653
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 4CENSUS: 4DATE:
05/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Rowena RamirezTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 05/30/24. LPA identified herself upon arrival, stated the purpose of the visit, and asked to speak with the Designated Facility Administrator (DFA). LPA met with Rowena Ramirez and a brief interview followed. LPA presented the DFA with a list of documents to be collected during the visit:

· LIC 500: Personnel Report

· LIC 308: Designation of Administrative Responsibility

· LIC 309: (for any LLC or Corp) if applicable

· LIC 402: Surety Bond, if applicable

· LIC 610E: Emergency Disaster Plan

· Copy of Liability Insurance

LPA noted DFA’s certificate # 6007486735 and it expires on 01/23/25.



LPA inspected 4 resident rooms. All had the required furniture, furnishings and lighting to be in compliance at the present time.

The LPA inspected the kitchen. All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. Opened food items in the refrigerator and cabinets were wrapped and dated appropriately.

LPA inspected a total of 2 bathrooms. Each contained soap, paper towels, and trash cans as required. Hot water was measured to ensure the temperature was between 105 and 120 degrees Fahrenheit in order to be in compliance. Hot water measured 107.6 degrees Fahrenheit.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RAMIREZ CARE HOME
FACILITY NUMBER: 347005390
VISIT DATE: 05/30/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The fire extinguisher was last serviced on 07/19/24 by Jorgensen Co. and was in compliance at the time of inspection.

The LPA observed medications were stored in a locked closet adjacent to the kitchen and inaccessible to residents in care. Medications were primarily the pill packs provided by the pharmacy. LPA reviewed storage, dosing, and destruction procedures. A review of the First Aid kit by the LPA found it to be complete and in compliance.

The exterior of the building was inspected by the LPA. There were no bodies of water or outbuildings present and the yard was completely fenced in. Screens and gutters were in good repair. There was also a shaded sitting area for residents to enjoy.

LPA observed the facility license, administrator's certificate, a menu calendar and residents' daily activity sheets.

LPA conducted a file review for the 4 residents in care. Each file was complete and in compliance. The LPA then reviewed 4 staff files. Those too were all complete and in compliance at the time of the inspection.

According to the California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit. A copy of this report was provided.

Exit interview.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2