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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700823
Report Date: 06/08/2020
Date Signed: 06/08/2020 01:23:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:BRIDGEWAY SENIOR CAREFACILITY NUMBER:
312700823
ADMINISTRATOR:DUMITRASCUTA, NOEMIFACILITY TYPE:
740
ADDRESS:313 WORDSWORTH CT.TELEPHONE:
(916) 220-2028
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: 0DATE:
06/08/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Noemi DumitrascutaTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA) Hiratsuka and Leitzell, contacted the facility Applicant via telephone due to COVID-19 and pre-cautionary measures. The purpose of this call is conducting an announced prelicensing visit. LPA spoke to Applicant/Administrator Noemi Dumitrascuta. Administrator held the camera to show LPAs the facility.

This facility has a fire clearance for five non-ambulatory and one bedridden residents. The main entrance opens to a hallway. On the right of the main entrance are two private bedrooms and across is a staff room. The hallway leads to the main common, kitchen, and dining areas in the back and to another hallway that goes left. The hallway to the left leads to one common half-bathroom, one common full bathroom, four private resident rooms, door leading to the garage, and laundry closet. All bedrooms have exits to the outside. The largest of the resident bedrooms has a full private bathroom. There are locked cabinets in each bathroom, one in the kitchen, and the staff bedroom. Medications are going to be kept in the staff room. All bathrooms have required grab bars and nonskid floors. The backyard was inspected. There are gates on both sides of the facility. There is a covered gazebo.

Component III orientation was complete.

This facility meets all regulations. LPA is going to submit this report to the application specialist for final review.

LPA is going to email a copy of this report to Administrator and Administrator is to sign, and email a copy back to LPA.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2020
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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