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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701462
Report Date: 10/28/2024
Date Signed: 10/29/2024 09:18:43 AM

Document Has Been Signed on 10/29/2024 09:18 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:FLORAL ADULT RESIDENTIAL CARE HOMESFACILITY NUMBER:
502701462
ADMINISTRATOR/
DIRECTOR:		KABBA, RAMATUFACILITY TYPE:
735
ADDRESS:5655 ROSELLE AVETELEPHONE:
(209) 271-1039
CITY:RIVERBANKSTATE: CAZIP CODE:
95367
CAPACITY: 4CENSUS: 0DATE:
10/28/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Ramatu KabbaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Announced Prelicensing visit made out to this facility on 1028/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility Applicant, Ramatu Kabba, who was briefly interviewed at this time.
Current census was 0 residents.
It was learned that this facility will be seeking to accept and retain up to (4) non ambulatory residents through vendorization with Valley Mountain Regional Center at any given time.
It was learned that this facility will have a program to be able to accept and retain Level 4I residents at any given time.
Tour of this facility was conducted.
Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.
Linen closet, located in the facility hallway, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time.
Kitchen area was toured.
Kitchen drawers and cabinets were opened and reviewed.
Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times.
Additional food storage units were observed to be present and functional at this time.
Laundry area, located near the garage area, was toured.
Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.
Administrator certificate for the facility designated Administrator, Ramatu Kabba, was observed to have been completed with certificate number #6070485735 that was set to expire on 06/26/2026 and in compliance at this time.
Medication cabinet, located in the facility living area, was observed to be locked and made inaccessible to
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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: FLORAL ADULT RESIDENTIAL CARE HOMES
FACILITY NUMBER: 502701462
VISIT DATE: 10/28/2024
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residents at this time.
First aid kit, located in the facility medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time.
Fire extinguishers, located throughout this facility, was observed to have been recently purchased at the local hardware store, Lowe's, on 06/12/2024 and in compliance at this time.
Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time.
Facility resident restrooms were toured.
Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees.
A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted.

Component III was conducted with the facility Applicant, Ramatu Kabba, at this time.

This facility was found to be in compliance at this time.

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

DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024
LIC809 (FAS) - (06/04)
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