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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577004611
Report Date: 01/03/2024
Date Signed: 01/03/2024 11:39:16 AM

Document Has Been Signed on 01/03/2024 11:39 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: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:
01/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Van and Peter Truong, Licensee/AdministratorTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced 1 year Annual Required Inspection and met with Administrator/ Licensees Van and Peter Truong. There are 4 residents at the facility, 3 were at Day Programs at the time of visit. There were 3 staff at the time of visit.

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. Bathroom water temperature measured 113 F. Each client's room was clean, well-organized and decorated for their individual interests. Facility has a sufficient supply of personal protective equipment (PPE). The Infection Control Plan was submitted 08/2022.

The back yard was full of plants, flowers and gardening opportunities for residents to enjoy.

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SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, LLC
FACILITY NUMBER: 577004611
VISIT DATE: 01/03/2024
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LPA requested the following documents:

LIC500
Proof of Liability Insurance
Lease Agreement
Proof of Surety Bond

No deficiencies were found at the time of inspection. No citations were issued.

Exit interview reviewed with Administrator/Licensees.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC809 (FAS) - (06/04)
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