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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701171
Report Date: 05/31/2024
Date Signed: 07/03/2024 01:38:29 PM

Document Has Been Signed on 07/03/2024 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:RAMENDRA & KAMLA PRASAD'S ARFFACILITY NUMBER:
502701171
ADMINISTRATOR/
DIRECTOR:		RADAZA, RODOLFOFACILITY TYPE:
735
ADDRESS:12091 E. WHITMORE AVETELEPHONE:
(209) 324-8355
CITY:HUGHSONSTATE: CAZIP CODE:
95326
CAPACITY: 4CENSUS: 4DATE:
05/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Tyrone Penny, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Renee Campbell made an unannounced visit to this facility to conduct an annual inspection on 05/31/2024 at 11:00 AM.  LPA Campbell met with Administrator Tyrone Penny and Direct Support Provider, Kimberly Davis and stated the purpose of today’s visit. LPA Campbell inspected the physical plant to ensure compliance with Title 22 regulations.

Upon entry to the facility, LPA Campbell was greeted by Direct Service Provider (DSP) Kimberly Davis. LPA Campbell entered and observed a resident being led to his bathroom by the DSP. The facility is a four bedroom, one story building with no body of water found. It is licensed to service mentally disabled adults between the ages of 18 and 59. There is a current census of 4 residents and five staff. LPA Campbell review three resident files and three staff files.

LPA Campbell toured the facility with DSP Davis, beginning with the kitchen. The refrigerator was observed to be at 37 degrees Fahrenheit and the freezer was measured at -1 degrees Fahrenheit. Items in both the fridge and refrigerator were observed with written dates for when items were opened.

When asked by LPA Campbell, DSP Davis displayed the locked sharps drawer in the kitchen and the locked resident medications in the cabinet with a first aid kit. The tour continued to a hallway off the kitchen where LPA Campbell observed a fire extinguisher that had last been inspected on 10/09/23. One residents bedroom was located in the hallway and it was locked because staff stated the resident was asleep. Cleaning products were observed locked away in a closet next to the laundry as well as under the kitchen sink.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RAMENDRA & KAMLA PRASAD'S ARF
FACILITY NUMBER: 502701171
VISIT DATE: 05/31/2024
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On the other side of the facility, LPA Campbell observed the bedrooms for additional residents. All residents rooms contained the required items such as : a bed, chair, closet, drawers and lamp. Each resident has their own bedroom. There are two bathrooms in the facility and both were in sanitary condition. LPA Campbell went to the backyard and observed a gated, shaded seating area. Outside of the gate, there was a trailer for two staff to live in. It was parked in front of a garage door that was open. Two staff were seated inside of the garage and socializing. The garage was empty except for a table and two chairs that staff were sitting in.

Based on observation, 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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
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