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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701172
Report Date: 09/01/2026
Date Signed: 09/01/2026 03:02:14 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/01/2026 03:02 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:YOUNG AT HEART RCFE NO.5 INCFACILITY NUMBER:
342701172
ADMINISTRATOR/
DIRECTOR:		SISAYAN, ISAGANIFACILITY TYPE:
740
ADDRESS:8039 CAYMUS DRIVETELEPHONE:
(916) 681-3689
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY: 6CENSUS: DATE:
09/01/2026
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Administrator- Glenda MolinyaweTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On September 1, 2026, at 2:00 PM, Licensing Program Analyst (LPA) Sulma Lopez arrived unannounced at the facility to conduct an annual required inspection. LPA Lopez met with Administrator (A1) Glenda Molinyawe and explained the purpose of today's visit.

The Administrator holds current certificate #7002475740 expires on October 23, 2027. The facility is licensed for (5) non-ambulatory residents and (1) bedridden resident ages 60 and over. The facility has an approved hospice waiver for (2) residents. The current census is 6 residents.

At 2:10 PM, LPA Lopez reviewed (5) resident and (3) staff files. The staff files contained all the required components and reflected ongoing training records. Resident files contained all the necessary components and updated records. LPA reviewed resident medication administration records. The facility documents on a paper Medication Administration Record (MAR) sheet each time medication is dispensed to a resident. Medications were observed to be stored in a locked cabinet.

At 2:40 PM, LPA toured the facility with A1. LPA Lopez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; facility bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. The facility was clean, safe, and in good repair. The facility temperature was 72 degrees.

LPA toured the resident bedrooms which were observed to be clean and free of hazards. The resident bedrooms were equipped with furniture in good repair. The bedding was clean and rooms were free of odors. LPA observed the facility restrooms. Toilets, hand washing, and bathing areas were sanitary and operational. All showers had non-slip mats and grab bars for safety. Continued on LIC 809-C.
Arielle Pascua
Sulma Lopez
DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YOUNG AT HEART RCFE NO.5 INC
FACILITY NUMBER: 342701172
VISIT DATE: 09/01/2026
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The facility has a linen storage with extra bedding and towels available. The dining room and living room areas were clean and free of hazards. Available seating was present to accommodate the current census. The facility fire extinguishers were serviced annually on November 13, 2025. LPA observed smoke and carbon monoxide detectors located on the walls. Alarms were in proper working condition.

LPA inspected the kitchen area which was clean and free of odors. The kitchen had at least 2 days of perishable food supply and at least 1 week of non-perishable food items. All kitchen appliances were in operational condition. Sharps and toxins were kept secured in locked cabinets.

The exterior of the facility was clear of debris and hazards. There were no bodies of water. LPA observed two shaded seating areas in the backyard. All outdoor passageways were kept free from obstruction. The fence was in good condition.

As a result of this annual inspection visit, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code. No deficiencies were cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.
NAME OF LICENSING PROGRAM MANAGER: Arielle Pascua
NAME OF LICENSING PROGRAM ANALYST: Sulma Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
LIC809 (FAS) - (06/04)
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