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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005183
Report Date: 12/04/2024
Date Signed: 01/09/2025 01:44:22 PM

Document Has Been Signed on 01/09/2025 01:44 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:FOUNTAINS SENIOR CARE, THEFACILITY NUMBER:
317005183
ADMINISTRATOR/
DIRECTOR:
MACIUCA, ESTERAFACILITY TYPE:
740
ADDRESS:231 CURRY COURTTELEPHONE:
(916) 899-5755
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
12/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Estera MaciucaTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 12/4/23 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Administrator, Estera Maciuca, arrived to assist.

There are 6 residents with 2 caregivers providing care.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. The home is very clean and residents interviewed stated they are happy with care.

LPA reviewed 6 resident files. Files are complete and well organized. Advised new admission agreements if move and records updated when hospice graduation.

LPA reviewed 2 staff files. Files are complete. Advised records completed timely and consider other staff to monitor files.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted with Administrator and copy of report left at the facility.
Maribeth SentyTELEPHONE: (916) 263-4813
Kevin MknellyTELEPHONE: (209) 814-1925
DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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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