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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577001978
Report Date: 08/26/2022
Date Signed: 08/26/2022 04:00:21 PM


Document Has Been Signed on 08/26/2022 04:00 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
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:
08/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Svetlana Burress, Administrator/LicenseeTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an inspection to check on readiness for residents.

Licensee/Administrator Svetlana Burress (SB) showed LPA throughout the facility. Every room was ready for occupancy. The living room and kitchen were well-appointed. The bathrooms all were equipped with handrails and shower chairs and non-slip mats. Fire clearance and RCFE Administrator's Certification are current.

Administrator/Licensee has made the facility homey and safe. She is preparing to add additional staff so that the number of hospice can be increased on the waiver. Currently the license is approved for one (1).

SB continues to add finishing touches, including additional outdoor shelter and seating for residents to enjoy time in the back and front yards in a safe environment.

There were no deficiencies noted at the time of visit.
No citations issued.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2022
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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