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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390332359
Report Date: 05/21/2024
Date Signed: 05/21/2024 01:38:58 PM

Document Has Been Signed on 05/21/2024 01:38 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:HANOT FOUNDATIONFACILITY NUMBER:
390332359
ADMINISTRATOR/
DIRECTOR:		REEVES, LAURA L.FACILITY TYPE:
735
ADDRESS:14373 EAST SARGENTTELEPHONE:
(209) 334-6454
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 30CENSUS: 23DATE:
05/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Tanya Newton TIME VISIT/
INSPECTION COMPLETED:
12:23 PM
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On 05/21/2024 at 9:00 AM, Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Tanya Newton and explained the purpose of the visit.

LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate. The facility is licensed for 30 ambulatory clients, which 5 may be non-ambulatory. There are currently 23 clients who reside at this facility.

The LPA Martinez toured the facility on 05/21/2024 at 11:45 AM.

LPA Martinez reviewed ten resident files, which all files were maintained. LPA Martinez reviewed ten staff files, and the files were maintained. LPA Martinez reviewed five PNI files, and all five PNI files were maintained. LPA Martinez reviewed two medication Administration records (MAR). Both MARs were maintained. The facility has a infection control plan. The last water analysis was on March 14, 2024. The last fire inspection was on May 17, 2024, and the last fire drill was on May 17, 2024. The facility has a natural disaster plan, and the last natural disaster drill was on April 18, 2024. The facility bathrooms, common areas, bedrooms, laundry room, and kitchen were sanitary and furnished. The facility has an areas for activities, and has shaded exterior furnished patios. The facility has a first aid kit, and all medication is stored in locked medication room.

As a result of this annual inspection, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was given to the facility at the end of the visit.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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