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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002800
Report Date: 07/18/2022
Date Signed: 07/18/2022 03:04:05 PM


Document Has Been Signed on 07/18/2022 03:04 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:SADDLEBACK LOVING HEARTSFACILITY NUMBER:
315002800
ADMINISTRATOR:MAGUREAN, TATIANAFACILITY TYPE:
740
ADDRESS:3400 BLUE GRASS DR.TELEPHONE:
(916) 844-4330
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:6CENSUS: 6DATE:
07/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Tatiana Magurean, AdministratorTIME COMPLETED:
03:30 PM
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LPA Tryon arrived at the facility unannounced to conduct an annual review using the Infection Control Domain of the CARES Tool. LPA self-screened before the visit, temperature was taken, possible COVID symptoms reviewed. LPA used hand sanitizer upon entry into the home
LPA met with Administrator Tatiana Magurean.

We reviewed the infection control domain of the CARES tool.

LPA also toured the facility including common areas, kitchen, dining area, hallways, bedrooms, bathrooms, food and medication storage, laundry, yard.

The facility appears to be clean, well-furnished and in good condition and very spacious. Residents have individual rooms.

Smoke detectors present and functioning. Fire extinguishers present and charged.

Food supplies appear to be adequate, varied and of good quality.

At this time, the facility appears to be in compliance with the regulations.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2022
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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