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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700848
Report Date: 08/31/2023
Date Signed: 08/31/2023 11:21:54 AM


Document Has Been Signed on 08/31/2023 11:21 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, 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: 4DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ioana Antone and David Antone, AdministratorsTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Bethany Mirlohi and Isabell Ramirez arrived unannounced to conduct an annual inspection. LPA met with Administrator Ioana Antone during today's inspection. LPA ensured they applied hand sanitizer before entering the facility.

LPA toured facility with Administrator to ensure health and safety of residents in care. LPA toured 5 resident rooms, 3 bathrooms, kitchen, common living spaces, backyard and the staff area. In the areas toured no immediate health, safety, or personal rights violations were observed. There is a garage/storage unit in the backyard. LPA toured the backyard and all exits are accessible and unlocked. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable.

LPA reviewed 2 of 4 resident files and 2 staff files. LPA reviewed medications of two residents comparing with Centrally Stored Medication Record and physician orders. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff files indicated training has been completed and first aid certificates were current. LPA observed a copy of current liability insurance.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
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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