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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701277
Report Date: 05/09/2024
Date Signed: 05/09/2024 12:45:18 PM

Document Has Been Signed on 05/09/2024 12:45 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:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Catherine Torrez, House ManagerTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 05/09/24, Licensing Program Analysts (LPA's) Renee Campbell arrived to the facility unannounced to conduct an post-licensing 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 available to work. The facility is a four bedroom, one floor building licensed to service ambulatory mentally disabled adults ages 18 to 59. No body of water was found on the premises.

Upon entry, LPA Campbell observed a See Something Say Something poster by the entrance of the facility. No residents were present as they were at school. Two staff were present. The thermostat was set at 70 degrees Fahrenheit. A First Aid kit was found to be complete with bandages, tweezers, scissors, thermometer and manual.

The refrigerator in the kitchen had a temperature of 32 degrees Fahrenheit for the refrigerator and -2 degrees Fahrenheit for the freezer and were within compliance. A weekly menu was observed attached to the refrigerator. The kitchen cabinets contained glasses, dishes and utensils. Next to the kitchen entrance by the entry door, there is a fire extinguisher as well that was last inspected on 06/17/2023. There were enough non-perishable pantry items in the pantry and stored in the garage to last the two residents and staff for 7 days. There were also enough perishable items in the refrigerator to last 2 days as well. Hot water was measured at 105.6 degree F.

The facility uses a combination smoke and carbon monoxide alarm that was tested by staff during the visit and found to be functioning. LPA Campbell provided technical assistance for the backyard. Wooden boards with rusty nails were observed beside an empty shed. LPA Campbell required that the boards be removed from the property or the nails be hammered down/removed. Staff removed and hammered any nails they could not removed

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)
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 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 inspected the 4 bedrooms and confirmed all had the required furniture and lighting to be in compliance at this time. Only two of the bedrooms were occupied. The LPA observed grab bars and non-skid surfaces in the 2 bathrooms along with paper towels and soap. No obstructions were observed in hallways.
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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