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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577004611
Report Date: 12/12/2024
Date Signed: 12/12/2024 01:53:32 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/12/2024 01:53 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/
DIRECTOR:
TRUONG, VANFACILITY TYPE:
735
ADDRESS:3755 CASTAIC COURTTELEPHONE:
(916) 730-5810
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 4CENSUS: 4DATE:
12/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:55 AM
MET WITH:Peter Truong, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced 1 year Annual Required Inspection and met with Licensee Peter Truong and Van Truong, Administrator/Licensee. There are 4 residents at the facility, 3 were at Day Programs at the time of visit.

Facility was found to be clean, orderly, and at a comfortable temperature with all exits free from obstruction. There were Christmas decorations and a tree which made the facility homey and festive. Toxins and sharps are stored in locked cabinets in kitchen and garage. There was an ample supply of perishable and non-perishable food, that were stored and labeled appropriately. 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 105 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). Facility has a nice Great Room with plenty of seating for socialization. There is also a small Activity Room with puzzles, a piano and treadmill for residents to enjoy. The back yard was full of plants, flowers and gardening opportunities. There is also a resident dog that provides joy and comradery.

LPA reviewed 4 of 4 resident files and 3 personnel files and found them to be complete.

LPA reviewed the Surety Bond and Liability Insurance.

There were no deficiencies found at the time of inspection. No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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