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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700848
Report Date: 09/09/2020
Date Signed: 09/10/2020 11:58:23 AM

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:JOANN'S HOME CARE LLCFACILITY NUMBER:
312700848
ADMINISTRATOR:ANTONE, DAVIDFACILITY TYPE:
740
ADDRESS:2829 BASELINE RD.TELEPHONE:
(916) 773-7142
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: 0DATE:
09/09/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Ioana "Joann" and David AntoneTIME COMPLETED:
02:27 PM
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Licensing Program Analyst(LPA) contacted the facility via telephone due to COVID-19 and pre-cautionary measures. The purpose of this call is conducting an announced prelicensing visit. LPA spoke to Applicants/Administrators Ioana "Joann" and David Antone . Applicant Ioana Antone, held the camera to show LPA the facility. This facility is undergoing a change in ownership.

This facility has a fire clearance for six non-ambulatory residents. This facility has five resident rooms. Three rooms are private. Two of the rooms may be shared; however, if one is shared, then the other is required to be private, or if both are shared, then one of the private rooms is required to be empty to ensure the facility does not go over capacity. Both of those rooms have full private bathrooms. The main entrance opens to the main common area on the left and towards the back on the left leads to one of the resident rooms that has a private bathroom and has an exit to the outside, a staircase leading to the second floor, a common bathroom, and storage under the staircase. The second floor is an open loft area that is the main living quarters for the applicants. To the right of the main entrance is a hallway that leads to one full common bathroom, four resident rooms, and a door leading to the garage. The largest bedroom in the hallway has a full private bathroom and an exit to the outside. And across the main entrance towards the back is the kitchen. The garage is off limits to the residents. The backyard has a covered patio and a locked shed.

LPA waived component III orientation because the administrator has prior working experience operating RCFEs.
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: 09/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2020
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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