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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577004611
Report Date: 12/01/2022
Date Signed: 12/01/2022 04:34:10 PM

Document Has Been Signed on 12/01/2022 04:34 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:V & P TRUONG CARE HOME, LLCFACILITY NUMBER:
577004611
ADMINISTRATOR:TRUONG, VANFACILITY TYPE:
735
ADDRESS:3755 CASTAIC COURTTELEPHONE:
(916) 730-5810
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 4CENSUS: 4DATE:
12/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Van Truong, Administrator/LicenseeTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced 1 year Annual Required Inspection and met with Administrator/ Licensee Van Truong. The inspection is focused on the Infection Control procedures and practices of this facility.

There is one entry point to facility. Upon entry; temperatures are taken, and screening questions are answered before visitors are allowed to enter the facility and all information is logged. Residents are screened and observed for any changes daily; all information is logged.

Facility was found to be clean, orderly, and at a comfortable temperature with all exits free from obstruction. Toxins and sharps are stored in locked cabinets in kitchen and garage. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications were stored and locked in kitchen cabinets making them inaccessible to residents. Exit alarms were on exit doors and working properly. All bathrooms had grab bars, and non-slip mat/flooring for bathing. All sinks had soap and paper towels. Each client's room was clean, well-organized and decorated for their individual interests. Facility has a sufficient supply of personal protective equipment (PPE).

Facility has 4 residents. Mitigation plan was approved by the Department on 03/05/21. The Infection Control Plan was submitted 08/2022. Fire inspection was done on 03/11/2022 with no violations.

The back yard had a garden area for residents to enjoy and participate in gardening activities.

No deficiencies were found at the time of inspection. No citations were issued. Exit interview reviewed with Administrator.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2022
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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