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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317027
Report Date: 03/23/2023
Date Signed: 03/23/2023 01:13:49 PM

Document Has Been Signed on 03/23/2023 01:13 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:
03/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Dumitru DragneaTIME COMPLETED:
01:15 PM
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On 3/23/23 Licensing Program Analysts (LPAs) Maja Jensen and Jennifer Fain arrived at facility unannounced to conduct a required 1 year annual visit. LPAs met with Dumitru Dragnea and explained the purpose of today's visit. Dumitru Dragnea holds current Administrator's certificate #6009293735 good through 8/27/24.

LPAs Jensen and Fain toured the facility including grounds and interior dining room, kitchen, living room, bedrooms, bathroom, laundry room. The were observed to be maintained and the backyard contained sufficient outdoor patio furniture and shade for use by the residents. All exterior paths were clear.

The entrance is equipped with a sign in station, visitor log, thermometer and hand sanitizer. There is COVID mitigation signs posted throughout the facility. The facility was observed to be sanitary and free of odor. There was adequate furniture and lighting throughout. The facility maintains emergency lighting and a supply of PPE. The carbon monoxide and smoke detectors were tested and found to be in good working order. The bedrooms were furnished with chairs, night stands, dressers and lamps. There is adequate linen on hand. The facility maintains a 2 day supply of perishable food and a 7 day supply of non-perishable food. All toxins, knives and medications were observed to be locked and inaccessible in care. The water temperature in the resident bathroom was measured at 113 degrees which falls within the required regulatory range of 105-120 degrees. The thermostat was set at 71 degrees which falls within the required regulatory range of 68-85. The first aid kit was determined to be complete. LPAs Jensen and Fain interviewed 3 of 4 residents and 1 of 1 care providers that were present. 4 of 4 resident files were reviewed and 1 staff file. The facility was determined to be in substantial compliance.

The comprehensive inspection tool was used for this annual visit. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2023
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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