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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002982
Report Date: 03/22/2023
Date Signed: 03/22/2023 12:47:02 PM


Document Has Been Signed on 03/22/2023 12:47 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:STONEBROOK LOVING HEARTSFACILITY NUMBER:
315002982
ADMINISTRATOR:DEMYAN, MICHAELFACILITY TYPE:
740
ADDRESS:11585 STONEBROOK DRTELEPHONE:
(916) 903-6459
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:6CENSUS: 0DATE:
03/22/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Liviu Magurean, ApplicantTIME COMPLETED:
01:00 PM
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On 3/22/2023 LPA Tryon visited the facility to conduct a pre-licensing visit. LPA met with applicant LIviu (Levi) Magurean. LPA used the CARE Inspection Tool to conduct the inspection.

LPA and applicant toured the facility including common areas, kitchen, food storage, bedrooms, bathrooms, laundry area, hallways, garage and yard. The facility is spacious and newly remodeled, nicely furnished and decorated. There is adequate space for activities inside and outside. Food supplies were present and adequate. Bedrooms appropriately furnished. Bathrooms have grab bars and non-slip shower surfaces. Potentially hazardous items and materials are stored and locked. Fireplace is glass-screened/covered for safety. Locked Medication closet is present. The facility has appropriate postings. Smoke and carbon monoxide detectors installed and functional. Two fire extinguishers present and charged.

Hot water temperature was checked and was above the range of 105 to 120 degrees F. The applicant turned down the thermostat on the hot water heater, and will send proof that the water has reached the appropriate temperature. The fence around the back yard is being re-built and is expected to be completed this week. Applicant will send proof upon completion.

Otherwise, the facility appears to be in compliance with regulations. As soon as LPA receives proof of the water achieving the appropriate temperature, Central Application worker will be notified/updated.

During the visit, LPA also reviewed the RCFE Orientation Component III with the applicant.
Applicant has now completed RCFE Orientation Component III.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
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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