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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005433
Report Date: 09/11/2026
Date Signed: 09/11/2026 12:09:11 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/11/2026 12:09 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:PRASAD'S CARE HOMEFACILITY NUMBER:
347005433
ADMINISTRATOR/
DIRECTOR:		SANJEETA PRASADFACILITY TYPE:
740
ADDRESS:4250 ARCHEAN WAYTELEPHONE:
(916) 431-7132
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 6CENSUS: 6DATE:
09/11/2026
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator Sanjeeta PrasadTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On September 11, 2026, at 9:00 AM, Licensing Program Analyst (LPA) Sulma Lopez arrived unannounced at the facility to conduct an annual required inspection. LPA Lopez met with Administrator (A1) Sanjeeta Prasad and explained the purpose of today's visit.

The Administrator holds current certificate #7005809740 and expires on February 02, 2027. The facility is licensed for 6 non-ambulatory clients. There are currently 6 residents who reside at this facility. The facility has an approved hospice waiver for 2. The facility is currently utilizing 1 out 2 hospice placements.

At 9:10AM, LPA conducted record reviews of 6 staff and 6 resident files. Resident files were observed to contain medical assessments, TB test records, medical consent forms, and admission agreements. LPA observed 2 out of 6 resident files contained outdated Needs and Services Plans (reappraisals). LPA also observed that 2 out of 6 resident pre-placement appraisals were not completed. Upon discovery, A1 completed the pre-appraisal form during the visit, and created a Service Plan for Resident 1 (R1). Staff records were observed to be missing Health Screen Reports, and Job Applications. LPA provided technical support for documentation expectations going forward. At 10:30AM, LPA reviewed 2 resident medication administration records. LPA observed that the facility utilizes a Medication Administration Record (MAR) sheet to document each time a medication is dispensed.

At 11:40AM, LPA toured the facility with A1. LPA Lopez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; facility bathrooms, laundry room, room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.
Continued on LIC 809-C.
Arielle Pascua
Sulma Lopez
DATE: 09/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: PRASAD'S CARE HOME
FACILITY NUMBER: 347005433
VISIT DATE: 09/11/2026
NARRATIVE
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LPA toured the facility kitchen and dining room area. The kitchen was clean, sanitary, and free of odors. The facility contained 2 days worth of perishable food items and at least 7 days of non-perishable foods. The facility stores medications and sharps in locked cabinets in the kitchen. LPA reviewed the facility's first aid kit and observed that it contained all the required components. The fire extinguishers were serviced annually on June 5, 2026. The hot water temperature was 111 degrees.

The living room area was observed to be clean and free of odors. There was enough seating available for the current census. The LPA observed activities available such as puzzles, games, and coloring items available for resident use. The LPA observed a public telephone available in the living room. The facility's temperature was 75 degrees. LPA toured the exterior of the facility. The exterior fence and side gate were in good repair. The walkways were free of obstructions. LPA observed a shaded patio area containing patio furniture for resident use.

LPA toured the restrooms with A1. LPA observed that the restrooms were clean and free of odors. The showers contained grab bars for resident safety. Hand washing supplies were present including soap, paper towels, and hand dryer.

LPA toured the resident bedrooms with A1. The bedrooms were observed to be clean, safe, and free of odors. Resident bedrooms were furnished with televisions, beds, dressers, closets, and night stands. The furniture was observed to be in good repair. Windows and window screens were also observed to be in good condition.

The LPA toured the laundry area which contained an operable washer and dryer. LPA observed that the facility stores detergent and cleaning supplies in locked cabinets above the laundry equipment. The LPA also observed extra bedding and linens available in the hallway and laundry areas.

LPA requested the following documents to be emailed or faxed within 15 days:
- LIC 500 Personnel Report, LIC 308 Designation of Facility Representative, LIC 610E Emergency Preparedness Plan.

As a result of this annual inspection, deficiencies were cited on the LIC 809-D. An exit interview was conducted and a copy of this report, LIC 809-D, and Appeal Rights were provided to the facility.
NAME OF LICENSING PROGRAM MANAGER: Arielle Pascua
NAME OF LICENSING PROGRAM ANALYST: Sulma Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 09/11/2026 12:09 PM - It Cannot Be Edited


Created By: Sulma Lopez On 09/11/2026 at 11:26 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2026
Section Cited
CCR
87457(c)

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87457 Pre-Admission Appraisal- (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria... This requirment is not met as evidenced by:
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The Licensee completed a pre-placement appraisal for R1 during the LPA's visit. Licensee agreed to review sections 87457 Pre-Admission Appraisal and 87455 Acceptance and Retention Limitations and email RO a signed acknowledgement of the regulations by 10/11/26 by 5:00PM.
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Based on observation, interviews, and records reviews, the Licensee did not ensure that 2 out of 6 residents had pre-placement appraisals completed before admission which poses a potential Health, Safety, or Personal Rights risk for persons in care.
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Type B
10/11/2026
Section Cited
CCR87463(a)

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87463 Reappraisals- (a) The pre-admission appraisal... shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition...
This requirement is not met as evidenced by:
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The Licensee created a Service Plan for 1 out of 3 residents whose Service Plans were outdated. The Licensee agreed to update Service Plans for the remaining residents and email copies to the RO by 10/11/26 by 5:00PM.
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Based on observation, interviews, and record reviews, the Licensee did not ensure that 3 out 6 residents' Needs and Services Plans were updated annually. LPA observed 3 outdated Service Plans which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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.
Arielle Pascua
NAME OF LICENSING PROGRAM MANAGER:
Sulma Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/11/2026 12:09 PM - It Cannot Be Edited


Created By: Sulma Lopez On 09/11/2026 at 11:39 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2026
Section Cited
CCR
87411(f)

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87411 Personnel Requirements- General- (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening...
This requirement is not met as evidenced by:
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LPA provided a copy of LIC 311F Records to be Maintained for RCFE. The Licensee agreed to review sections 87411 Personnel Requirements- General and 87412 Personnel Records and email signed statements of acknowledgement of the regulations to the RO by 10/11/26 by 5:00PM.
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Based on observation, interviews, and record reviews, the Licensee did not ensure that 2 out of 5 staff records contained completed and signed health screening reports which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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.
Arielle Pascua
NAME OF LICENSING PROGRAM MANAGER:
Sulma Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2026


LIC809 (FAS) - (06/04)
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