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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701090
Report Date: 10/08/2024
Date Signed: 10/08/2024 12:00:25 PM

Document Has Been Signed on 10/08/2024 12:00 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:RIVMAGS CARE HOME LLCFACILITY NUMBER:
392701090
ADMINISTRATOR/
DIRECTOR:		ONGA, SHERONFACILITY TYPE:
735
ADDRESS:2112 WALL STTELEPHONE:
(209) 362-6871
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 4CENSUS: 4DATE:
10/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Cheryl MagasayoTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On 10/8/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual visit. LPA Jensen met with Licensee Cheryl Magasaya and explained the purpose of the visit. The facility has a capacity of 4 and currently there are 4 residents.

LPA Jensen toured exterior and observed the grounds to be well maintained. All paths were free of obstruction. There are no bodies of water on the property. There are shaded areas and patio furniture available for outdoor activities. LPA Jensen inspected the interior and observed the facility to be sanitary and free of odor. Adequate lighting and furnishings were observed. The facility maintains extra linens to allow for frequent changes. Night lights were observed in the hallways. There are grab bars in the bathrooms. LPA Jensen inspected the kitchen and determined there was in excess of a two day supply of perishable food and a 7 day supply of non-perishable food. Food in the freezer was not labeled. Technical assistance is being provided and a food storage guide from the Federal Food and Drug Administration was provided. The thermostat was set at 70 degrees and the water temperature was within required range. The carbon monoxide detector was checked and determined to be good working order. The fire extinguisher was last serviced on May 10, 2024 and is in compliance. The first aid kit was determined to be complete. Medications, knives and toxins are locked and inaccessible to residents in care. The LIC 610 was reviewed and is in compliance. LPA Jensen reviewed the liability insurance which is and good through 11/28/24. There is a surety bond in effect for $2000. LPA Jensen conducted a random audit of P&I funds ad determined the accounting to be accurate. LPA Jensen interviewed 1 resident who stated she is happy with the facility and program. All other residents were at day program. LPA Jensen observed lunch service and food served accurately reflected what was on the menu. LPA Jensen reviewed staff files and resident files and determined they were complete and organized. Staff had appropriate clearances and training.

The facility was determined to be in substantial compliance and no deficiencies were observed. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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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