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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005479
Report Date: 08/14/2024
Date Signed: 08/14/2024 10:59:56 AM


Document Has Been Signed on 08/14/2024 10:59 AM - 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:RENAISSANCE SENIOR CAREFACILITY NUMBER:
347005479
ADMINISTRATOR:LILLI LAPADATFACILITY TYPE:
740
ADDRESS:7316 MAIN AVENUETELEPHONE:
(916) 932-4303
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 4DATE:
08/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Co-administrator- Gabriel Bercea TIME COMPLETED:
11:00 AM
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On 08/14/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to conduct a required 1 year inspection utilizing the care tool. LPA met with Co-administrator- Gabriel Bercea (S1) and explained the purpose of the visit. S1 stated that Administrator, Lilli Lapadat was on vacation and S1 will assist LPA with today's inspection.

LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to residents bedrooms, bathrooms, kitchen, dining room, common areas, storage area, and laundry room. LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. The temperature in the facility was 78 degrees. First aid kit was completed. LPA observed fire detectors and carbon monoxide detectors to be operable. LPA observed the fire extinguisher, located in common area , which was last inspected on 01/30/24 and was ready for emergency use. LPA reviewed fire and disaster drill logs, which are conducted quarterly. LPA observed required Licensing posters posted throughout the facility.

LPA conducted a file review of two (2) personnel and two (2) residents records. Both personnel and resident records are found to be complete. Medications are centrally stored, locked, and appear to be given per doctor order. LPA compared medications to those being given for two (2) residents and found no discrepancies.

No deficiencies are being cited during today's inspection per Title 22 regulations.

Exit interview conducted and copy of the report was left at the facility.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024
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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