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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700044
Report Date: 10/31/2023
Date Signed: 10/31/2023 04:29:43 PM


Document Has Been Signed on 10/31/2023 04:29 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:OLTEAN'S HOME CAREFACILITY NUMBER:
342700044
ADMINISTRATOR:OLTEAN, DIANNEFACILITY TYPE:
740
ADDRESS:4213 WALNUT AVETELEPHONE:
(916) 484-1763
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
10/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:co-Administrator Mariana OlteanTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Required-1 Year Inspection utilizing the care tool. LPA met with co-Administrator Mariana Oltean, and explained the purpose of the visit.

LPA observed six resident present at the facility, with one resident on hospice services. Facility has approved hospice waiver of four.

During today's inspection, LPA toured the facility to ensure the health and safety of the residents in care. Areas toured include but are not limited to: five resident bedrooms, kitchen, two bathrooms, dining room, garage and common areas. LPA observed sharps and medications to be locked and secured. LPA observed facility to have adequate food supply, 2+ days of perishables and 7+ days of non-perishable foods. In the areas toured no immediate health, safety, or personal rights violations were observed.

Additionally, LPA observed the posted Administrator Certificate to be expired 05/15/22 but LPA confirmed Administrator Certificate #6040232740 has been renewed. LPA informed co-Administrator LPA will contact Admin Cert unit for a copy of the certificates.

LPA conducted a file review of three residents and three personnel records,and observed the files to be complete. LPA completed the care tool and found facility to be in compliance. No deficiencies cited.

At this time, LPA requested a copy LIC 500 and liability insurance to be emailed to LPA by Friday November 3, 2022.

Exit interview conducted and copy of report was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2023
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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