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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701277
Report Date: 05/09/2024
Date Signed: 07/03/2024 01:27:01 PM

Document Has Been Signed on 07/03/2024 01:27 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:RIVERETTE RESIDENCEFACILITY NUMBER:
502701277
ADMINISTRATOR/
DIRECTOR:		SANDHU, JEEVANJOATFACILITY TYPE:
735
ADDRESS:1409 RIVERETTE DRIVETELEPHONE:
(209) 531-6694
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 4CENSUS: 2DATE:
05/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Catherine Torrez, House ManagerTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 05/09/24, Licensing Program Analysts (LPA's) Renee Campbell arrived to the facility unannounced to conduct an annual inspection. LPA Campbell met with Catherine Torrez ,House Manager and explained the purpose of the visit. The current census is 2 residents with 8 staff.  

The facility is a four bedroom, one floor building licensed to service mentally disabled adults ages 18 to 59 who are ambulatory only. No body of water was found. Upon entry, LPA Campbell observed that no residents were present as they were at school. Two staff were present.

LPA Campbell inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyard of the facility to ensure compliance with Title 22 regulations.  The facility was observed to be free of odor and in good repair. LPA Campbell observed that the current two residents used the common bathroom. There were two unoccupied master bedrooms with en suite bathrooms. The hot water temperature was measured in the resident bathroom at 105.6 degrees Fahrenheit which is within the required maximum range of 105 to 125 degrees Fahrenheit.  The hallway bathroom was used by the rest of the residents, staff and guests.  There were no changes to the building layout since the most recent floor plan. 
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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: RIVERETTE RESIDENCE
FACILITY NUMBER: 502701277
VISIT DATE: 05/09/2024
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LPA Campbell observed a washer and dryer in a closet. Cleaning supplies were locked in a cabinet beside the laundry closet.  The temperatures for the freezer and the refrigerator were in compliance. The garage was not inaccessible to residents and contained a seven day supply of non-perishable foods. No cleaning supplies or dangerous items were observed. In the kitchen, LPA Campbell observed a two day supply of perishable foods for residents, sharps that were locked away and inaccessible to residents.

The outdoor area was toured by LPA Campbell and House Manager Torrez. The backyard was surrounded by fruit trees and completely fenced in. Two chairs were observed under a shaded patio and a paved path lead to the fire exit. LPA Campbell observed two sheds in the backyard as well. One shed was locked and contained the lawn mower and other yard equipment. Another shed was unlocked and empty.

Of the two residents residing in the facility, LPA Campbell reviewed two files. Of the eight staff employed by the facility, LPA Campbell reviewed two files.

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility. 
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC809 (FAS) - (06/04)
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