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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317027
Report Date: 03/14/2022
Date Signed: 03/14/2022 04:27:04 PM

Document Has Been Signed on 03/14/2022 04:27 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:CORINA CARE HOMEFACILITY NUMBER:
340317027
ADMINISTRATOR:DRAGNEA, DUMITRUFACILITY TYPE:
735
ADDRESS:8801 WILLIAMSON DRIVETELEPHONE:
(916) 685-0975
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 4DATE:
03/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Luminita Gheorge, Assistant AdministratorTIME COMPLETED:
03:35 PM
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At 1:20pm, LPA T. White arrived unannounced to conduct a Required 1-year Annual inspection. LPA met with Assistant Administrator, Luminita Gheorghe and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 4 ambulatory clients.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. There are no bodies of water observed. A comfortable temperature for clients is maintained at 70 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 111.1 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. There is a minimum of 7-day nonperishables and 2-day perishables foods.

Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on June 04, 2021. LPA observed completed mitigation plan. First aid kit was observed to be complete. Fire drill was last conducted on 02/07/2022. LPA reviewed 2 client files and P & I money. LPA reviewed 2 staff records.

LPA requested LIC 500 - Personnel Report be submitted to CCLD by 03/18/2022.

No deficiencies cited during inspection.

Exit interview conducted with Assistant Administrator and a copy of report given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Treana White
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2022
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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