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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585002999
Report Date: 09/11/2024
Date Signed: 09/11/2024 10:37:07 AM

Document Has Been Signed on 09/11/2024 10:37 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AURORA HOME CAREFACILITY NUMBER:
585002999
ADMINISTRATOR/
DIRECTOR:
ARCHELIE SAYAGOFACILITY TYPE:
735
ADDRESS:5721 GLOWHAVENTELEPHONE:
(530) 443-2705
CITY:MARYSVILLESTATE: CAZIP CODE:
95901
CAPACITY: 4CENSUS: 0DATE:
09/11/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Archelie and PaulJohn SayagoTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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LPA Hiratsuka conducted this announced annual visit. The reason this visit is announced is because there are no residents at this time. LPA met with Administrator and Licensees Archelie and PaulJohn Sayago.

This facility has a fire clearance for three ambulatory and one non-ambulatory resident. There are four private resident rooms, one full private bathroom in a resident room, one full shared bathroom, a laundry room, a large open area with kitchen, and a door leading to the garage. There are locked cabinets for cleaning toxins and personal items in the bathrooms. There are locked cabinets for medications in the kitchen. Since there is no staff room this facility is required to have awake staff at all times.

A few topics were discussed.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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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