347005713-6-1-2022-27-AS-JICY-CEYTNU-20220601145320

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 347005713
Report Date: 06/01/2022
Date Signed: 06/01/2022 02:54:06 PM

Document Has Been Signed on 06/01/2022 02:54 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:	DANIEL RESIDENTIAL CARE HOME LLC		FACILITY NUMBER:	347005713
ADMINISTRATOR:	DIALA, JOYCE		FACILITY TYPE:	740
ADDRESS:	4295 AMAPOLA WAY		TELEPHONE:	(916) 717-3263
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	6	CENSUS: 0	DATE:	06/01/2022
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	See Form Below		TIME COMPLETED:	11:00 AM

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	An announced office meeting was conducted on June 1, 2022 in the Sacramento South Regional Office via Microsoft Teams. The purpose of this office meeting was to discuss the deficiencies observed on visit 05/20/2022 and to discuss the Administrator's plan to mitigate the spread of a current rash observed on 2 residents. Present in the meeting representing Community Care Licensing Sacramento South, was Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Analyst (LPA) Christina Valerio, Licensing Program Analyst (LPA) Jamie Ivey Canady, and Daniel Residential Care Home LLC representatives Emmanuel Diala and Joyce Diala. Topics discussed during the meeting: Unannounced Visit on 05/20/2022 Health and Safety of Residents Follow-up Appointments Universal Precautions Administrator Responsibility Reporting Requirements Bi-Weekly Progress Reports Cont on 809-C

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022

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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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: DANIEL RESIDENTIAL CARE HOME LLC	FACILITY NUMBER: 347005713
	VISIT DATE: 06/01/2022

NARRATIVE

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The facility has stated they will do the following to achieve continued and improved compliance:

Remove "Death Report" from verbiage on outgoing fax cover sheet to Community Care Licensing (CCL), unless facility is in fact reporting a resident death.

Professional cleaning monthly. Licensee will submit professional cleaning invoice to LPA Ivey Canady monthly until further notice from CCL.

Provide progress reports, regarding all resident rashes, every 2 weeks beginning 6/13/2022. Documentation to be sent to attention LPA Ivey Canady via fax.

Maintain documentation in residents' file to show all medications received.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited during this visit. An exit interview was conducted with Administrator Emmanuel Diala. A copy of this report was provided via email and an electronic email read receipt confirms receiving these documents. Administrator Emmanuel Diala will sign the document and send signed copy to LPA Ivey Canady at jamie.ivey-canady@dss.ca.gov.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022

LIC809 (FAS) - (06/04)

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