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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585002999
Report Date: 06/19/2023
Date Signed: 06/19/2023 12:15:49 PM

Document Has Been Signed on 06/19/2023 12:15 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AURORA HOME CAREFACILITY NUMBER:
585002999
ADMINISTRATOR:JOHNSON, EMILYNFACILITY TYPE:
735
ADDRESS:5721 GLOWHAVENTELEPHONE:
(530) 443-2705
CITY:MARYSVILLESTATE: CAZIP CODE:
95901
CAPACITY: 4CENSUS: 0DATE:
06/19/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Emilyn Johnson, Admin; Paul Sayago, Archelie SayagoTIME COMPLETED:
01:00 PM
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On this date LPA Tryon visited the facility to do a Pre-licensing visit. This is a new house and has never been a care home before, LPA met with Paul and Archelie Sayago and Emilyn Johnson.
LPA toured the house with the applicants including common areas, kitchen, dining area, bedrooms, bathrooms, storage, laundry room, garage and outside/patio area. The home is new construction and in new condition. The house is appropriately furnished with bedroom, living room, dining room furniture. Bedrooms are furnished as per regulation. The kitchen is appropriately furnished with cooking dishes and utensils, dishes, eating utensils, etc. Food is adequate including perishable and non-perishable supplies. House is free of any noted dangers or obstructions at this time. Smoke detectors and carbon monoxide detector installed. Fire extinguisher available and charged. Sharp items/knives locked. There is locked storage available for medications. Cleaning chemicals are locked. First aid supplies available.
Appropriate information is posted as per regulation including client rights, who to contact regarding complaints, emergency/disaster form, etc.
Hot water is set at 120 degrees F, within the regulation limit.
At this time, the facility appears to be in good condition and appropriately furnished, postings are present,etc.

LPA reviewed ARF Orientation Part III. The applicants have successfully completed Orientation.

Exit interview completed.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2023
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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