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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700611
Report Date: 04/18/2023
Date Signed: 04/18/2023 01:33:45 PM

Document Has Been Signed on 04/18/2023 01:33 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:QURESHI CARE HOMEFACILITY NUMBER:
392700611
ADMINISTRATOR:UMER QURESHI, MUHAMMADFACILITY TYPE:
735
ADDRESS:9555 PRISCILLA LANETELEPHONE:
(209) 565-5258
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 5CENSUS: 5DATE:
04/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Muhammed Ali Qureshi, AdministratorTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Renee Campbell conducted an unannounced Annual 1-Year Required visit on 04/18/2023. LPAs met and toured with Administrator, Muhammed Ali Qureshi (#6049973735 exp 10/24/2024) and explained the purpose of the visit.

LPAs toured the facility including but not limited to bedrooms, 2 bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms of which 5 bedrooms are occupied by the clients. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the clients. The hot water temperature in the clients’ shared bathroom was measured at 116 degrees Fahrenheit. Clients’ bathrooms are equipped with grab bars There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods.

LPA Renee Campbell inventoried medication by comparing MAR to medications that were present in client medication baskets. This included all resident MAR's for March and April. All medications were dispensed as directed unless residents were hospitalized or on a home visit. All staff have been cleared and are associated with the facility.

Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on September 28,2022. Emergency Disaster Plan was last posted on 01/01/2023. First aid kit was observed to be complete. Fire drill was last conducted on 04/01/2023.
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2023
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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