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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577001978
Report Date: 02/10/2023
Date Signed: 02/10/2023 04:19:53 PM


Document Has Been Signed on 02/10/2023 04:19 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: 1DATE:
02/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Svetlana Burress, Administrator/LicenseeTIME COMPLETED:
04:30 PM
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LIcensing Program Analyst Jill Nakagawa arrived unannounced on 02/10/23 at approximately 02:40 PM 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.

There is currently one resident: the facility is just getting back into operation. The other resident rooms are furnished nicely and ready for occupancy. All visitors, essential visitors, and staff are screened prior to entry, 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. 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 in kitchen cabinet making them inaccessible to residents. 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. There is an approved hospice waiver for one (1) resident. Mitigation plan was approved by the Department on 03/30/22. Infection Control Plan was submitted. Fire clearance is approved for six (6) non-ambulatory.

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: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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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