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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002794
Report Date: 04/28/2023
Date Signed: 04/28/2023 02:51:44 PM


Document Has Been Signed on 04/28/2023 02:51 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:LOVE & LIGHTFACILITY NUMBER:
315002794
ADMINISTRATOR:ROMANOVA, LARISAFACILITY TYPE:
740
ADDRESS:6032 CRATER LAKE DR.TELEPHONE:
(916) 749-3181
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 5DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Larisa Romanova, Administrator, Doru Juganaru, Administrator TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the full inspection care tool. LPA met with Larisa Romanova, Administrator, and Doru Juganaru, Administrator, and explained the purpose of today's inspection.
LPA observed (2) clients in the common areas and (3) resident in their rooms at the start of the inspection. One resident had (2) visitors with him in his room. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently, there are (0) residents on hospice.

LPA and Administrators toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms, (1) shared resident bedroom, (3) resident bathrooms, staff room, kitchen, laundry and garage. LPA observed the facility to be clean, in good repair and odor-free. LPA observed each bathroom to have the necessary grab bars, non-skid flooring, paper towels, trash can with lid and 20-second hand-washing poster. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food and sharps and medications to be locked in the kitchen. All toxins are locked in the laundry area. LPA observed sufficient PPE supplies.. The inside temperature measured 78*F. The smoke/monoxide alarms were working and the fire door closed automatically when alarm was sounded. There is (1) unlocked gate on the inside back patio and outside seating. LPA reviewed (1) of (5) resident files and found it to contain current documentation. LPA reviewed (2) staff files and found them to contain current documentation with current First Aid/CPR certification and current/pending RCFE Administrator certificates. Hot water measured 110*F in one bathroom. LPA observed all required postings to be posted and several Covid posters. Facility has an approved Infection Control Plan. Emergency Disaster Plan was updated 3/1/23. Both staff are cleared and associated to the facility. An updated copy of liability insurance was obtained. LPA requested an updated copy of LIC308 and LIC500 be sent to the Department by 5/5/23.

There are no citations issued; however, there is a Technical Advisory Note during today's inspection. Exit interview. Copy of report provided to Administrators.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
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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