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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507003973
Report Date: 09/22/2021
Date Signed: 09/22/2021 12:06:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:PRATHNA RESIDENTIAL CARE FACILITY FOR THE ELDERLYFACILITY NUMBER:
507003973
ADMINISTRATOR:PRASAD, MUKESHFACILITY TYPE:
740
ADDRESS:3708 CARLISLE COURTTELEPHONE:
(209) 577-2133
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:5CENSUS: 4DATE:
09/22/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Shirley Tudence TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility to conduct a POC visit. LPA met with facility staff Shirley Tudence and explained the purpose for todays visit. LPA observed a brand new fire extinguisher located in the kitchen area with a receipt attached. LPA also observed a sufficient supply of non perishable, and also perishable foods. Deficiencies from 809D dated 09/20/2021 will now be cleared.POC letters printed, and left at the facility.


Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah HurtTELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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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