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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002307
Report Date: 07/18/2023
Date Signed: 07/18/2023 11:56:56 AM


Document Has Been Signed on 07/18/2023 11:56 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:ESTERA'S HOME CARE IIFACILITY NUMBER:
315002307
ADMINISTRATOR:NICULAI, ESTERAFACILITY TYPE:
740
ADDRESS:1744 WOODLEAF CIRCLETELEPHONE:
(916) 257-3621
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:5CENSUS: 0DATE:
07/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Leon NiculaiTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. Upon arrival LPA knocked on the door and there was no answer. LPA called the Administrator Estera Niculai and administrator informed LPA that the facility is empty. LPA met with Administrator's husband Leon Niculai during today's inspection.

LPA toured the facility with Leon Niculai. LPA observed no one is living at the facility. Leon Niculai and administrator informed LPA that they are doing updates to the property. At this time the administrator is not admitting residents to the home.

No deficiencies cited during today's inspection.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Bethany MirlohiTELEPHONE: (916) 204-8288
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2023
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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