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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005433
Report Date: 09/19/2022
Date Signed: 09/19/2022 04:02:17 PM


Document Has Been Signed on 09/19/2022 04:02 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:PRASAD'S CARE HOMEFACILITY NUMBER:
347005433
ADMINISTRATOR:SANJEETA PRASADFACILITY TYPE:
740
ADDRESS:4250 ARCHEAN WAYTELEPHONE:
(916) 431-7132
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 6DATE:
09/19/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Elaina AtienzaTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analysts (LPA) Albert Johnson and Kesha Lewis arrived to the facility and met with Staff Elaina Atienza to conduct POC Inspection from 809 and 809-D dated 8/15/22

During the visit on 8/15/2022, LPA Johnson requested a completed fire /disaster drill, conduct in-service training with staff to ensure that all items that could pose a danger to residents are kept locked and inaccessible at all times and for the Administrator to obtain an updated 602 for identified residents in 10 days.

All deficiencies from the visit on 8/15/2022 have not been cleared. The facility will need to complete a fire drill today (9/19/2022). The other three citations have been cleared. The facility has not paid the annual fee for 2022, which was due in August and has not been paid according to LIS (licensing information systems). The facility refrigerator will need to be cleaned out and staff food labeled.

Per the Title 22, Division 6 of California Code of Regulations. Deficiencies were observed during today's inspection.


Exit interview conducted.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
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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Document Has Been Signed on 09/19/2022 04:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833


FACILITY NAME: PRASAD'S CARE HOME
FACILITY NUMBER: 347005433

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2022
Section Cited

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Licensing Fees:
A late fee that represents an additional 50 percent of the established annual fee when any licensee fails to pay the annual licensing fee on or before the due date as indicated by postmark on the payment.
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This requirement was not met as evidencied by records reviewed in LIS the fee due was on 8/29 /22 , has not been paid. Fees due total is $742.00 including late fee.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
LIC809 (FAS) - (06/04)
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