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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577001978
Report Date: 04/22/2022
Date Signed: 04/22/2022 11:33:54 AM


Document Has Been Signed on 04/22/2022 11:33 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:ANISIA'S HEALTHY LIVINGFACILITY NUMBER:
577001978
ADMINISTRATOR:BURRESS, SVETLANAFACILITY TYPE:
740
ADDRESS:1904 MICHIGAN BLVD.TELEPHONE:
(916) 372-3174
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:6CENSUS: 0DATE:
04/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Svetlana Burress, Licensee/AdministratorTIME COMPLETED:
11:40 AM
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LIcensing Program Analyst Jill Nakagawa arrived unannounced on 4/22/22 at approximately 9:00 AM for a Required- Annual Inspection and met with Administrator/Licensee Svetlana Burress. The inspection is focused on the Infection Control procedures and practices of this facility.

Currently there are no residents at the facility, but Covid protocols have been set up. All visitors, essential visitors, and staff will be screened upon entry; Temperatures will taken, and screening questions are to be answered before being allowed to remain in the facility, all information will be logged. Residents will be screened and observed for any changes, all information will be logged. Facility was found to be clean, orderly, and at a comfortable temperature with all exits free from obstruction. Toxins are stored in locked cabinets. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications were stored locked making them inaccessible to residents and staff that do not handle medications. All exit alarms were on exit doors and working properly. All bathrooms had grab bars, and non-slip mat/flooring for bathing as needed. Facility has a sufficient supply of personal protective equipment (PPE). Administrator/Licensee had a mask on during the LPA's inspection. Facility There is an approved hospice waiver for one (1) resident. Mitigation plan was approved by the Department on 03/30/22. Fire clearance is approved for six (6) non-ambulatory.
There were no residents in care at the facility during this inspection.

No deficiencies during today's inspection.
No citations issued.
Exit interview conducted with the Licensee/Administrator.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022
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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