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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700311
Report Date: 06/21/2023
Date Signed: 06/21/2023 04:22:51 PM


Document Has Been Signed on 06/21/2023 04:22 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:ABOUTLIFE CARE FACILITYFACILITY NUMBER:
312700311
ADMINISTRATOR:SCUTARU, ELIZAVETAFACILITY TYPE:
740
ADDRESS:2705 LUPINE CTTELEPHONE:
(916) 844-8540
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 5DATE:
06/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Tatiana Danu, Administrator TIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a quarterly on-site case management inspection pursuant to a Stipulation and Waiver and Order adopted on 6/10/2022. LPA met with Tatiana Danu,Administrator, and explained purpose of inspection. Also present was Elizaveta "Eliza" Scutaru, Co-Administrator and Olena Dymytresku, volunteer staff. LPA observed (3) residents in the common area and (2) residents in their rooms and a podiatrist to be on site during the inspection.

During today's inspection, LPA reviewed the "Compliance Binder" and observed it to be organized and to contain tab dividers for each requirement as set forth in in the Stipulation. LPA observed a copy of the probationary license to be posted as well as the Stipulation. LPA observed the Elopement Policy and Procedure and Elopement Prevention Policy to be in the binder along with documentation for elopement drills conducted in October 2022 and April 2023. Also in the binder were staff training certificates from October 2022 and April 2023 addressing elopement. The next scheduled training is in October 2023. LPA observed additional training certificates in each staff's binder.

LPA and Administrator toured the interior and exterior of the home. Several exit door alarms were tested and found to be in working order. Specifically, there are (3) alarms on each exit door that were added in May 2021. Each alarm sounds to a different device, including the system monitor, Alexa device and staff cell phones. Batteries are checked quarterly to ensure they are always in working order. Additionally, there are non-audio cameras throughout the common areas only and around the outside perimeter of the facility.

The home is well-maintained and residents appear to have their needs met.

Exit interview. Copy of report given to the Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
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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