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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701277
Report Date: 06/19/2023
Date Signed: 06/27/2023 11:29:40 AM

Document Has Been Signed on 06/27/2023 11:29 AM - 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:RIVERETTE RESIDENCEFACILITY NUMBER:
502701277
ADMINISTRATOR:SANDHU, JEEVANJOATFACILITY TYPE:
735
ADDRESS:1409 RIVERETTE DRIVETELEPHONE:
(209) 531-6694
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 4CENSUS: 0DATE:
06/19/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jeevanjoat SandhuTIME COMPLETED:
01:00 PM
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Announced Prelicensing visit made out to this facility on 06/19/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility Applicant Jeevanjoat Sandhu. Brief interview was conducted with the facility Applicant at this time.
This Applicant is seeking licensure for a 4-bed ARF to accept and retain adult residents at any given time. This Applicant is also seeking vendorization through Valley Mountain Regional Center for Level 41 residents at this time.
There were no residents in care at this time.
Tour of this facility was conducted.
Kitchen area was toured. Cabinets and drawers were opened and reviewed at this time. Silverware, plates, and utensils were observed to be sufficient to meet the needs of the residents at this time.
Knives, cleaning agents, and bleach were observed to be locked and made inaccessible to the residents at this time.
Food storage unit, facility refrigerator, was observed to be functional and in good repair at this time.
Food supply was reviewed for adequate 2-day perishables and 7-day non perishables quantities at this time. Pantry area was reviewed as well for additional non perishable food items.
It was learned that this facility will not employ staff who are live-in caregivers but have staff working shifts throughout the day/night for proper 24 hour care and supervision.
Furniture and furnishings were observed to be sufficient and in compliance at this time.
Living area, dining area, and all other areas intended for resident use were observed to be furnished and sufficient to meet the needs of the residents at this time.
Fire extinguisher (1) was observed to be positioned in the entry way to this facility and was recently reviewed by the local fire extinguisher company and observed to be in compliance at this time.
Linen closet was observed to be stocked with an adequate supply of sheets, bedding, and blankets to meet the needs of the residents at this time.
A tour of the resident bedrooms (4) was conducted.
Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: RIVERETTE RESIDENCE
FACILITY NUMBER: 502701277
VISIT DATE: 06/19/2023
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A tour of the resident restrooms (2) was conducted.
Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees at all times.
Laundry area was toured. The doors leading into this area was observed to be locked and made inaccessible to the residents at this time.
Detergents, bleach, and all other cleaning supplies were observed to be stored in a cabinet that was locked and made inaccessible to the residents at this time.
First aid kit was observed to be present and contained all of the required components at this time.
Garage area was toured.
It was learned that this space will only be used as a storage unit to stock supplies and resident related belongings/items in the future.
A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gate, and all exits was conducted.

This facility, and its Applicant, has been found to be in compliance at this time.

Component III was waived since this Applicant has already gone through this process with prior licensure of facilities in the past.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
LIC809 (FAS) - (06/04)
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