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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700044
Report Date: 09/19/2024
Date Signed: 09/19/2024 04:17:54 PM


Document Has Been Signed on 09/19/2024 04:17 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:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:26 PM
MET WITH:Licensee Mariana Oltean TIME COMPLETED:
03:35 PM
NARRATIVE
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On 9/19/2024, Licensing Program Analysts (LPAs) Yang and Mikkelson arrived at the facility to conduct a required annual inspection utilizing the full CARE tool. LPAs met with caregiver, Capresa Nichol, who then contacted Licensee, who arrived to the facility shortly afterwards.

Today's visit, facility census is six resident with three on hospice services. Facility is licensed for six non-ambulatory, hospice waiver of four.

During today's inspection, LPAs observed four residents in their bedrooms, and two residents in the common areas. Areas toured with Licensee included but not limited to: five resident bedrooms, one bathroom, garage, kitchen and the common areas. LPAs observed facility to have sharps, toxins and medications to be locked and secured. No immediate health, safety and personal rights violation observed.

Medication audit was conducted for three residents in care.

LPAs conducted file review of five resident records and five personnel records. LPAs observed required training hours for S1, S2 and S3 to be incomplete. LPAs provided facility a copy of Health and Safety Code §1569.625 Staff training; legislative findings;contents

LPAs reviewed facility Emergency Disaster Plan and Fire Earthquake Drill records. Liability insurance was confirmed to be active.

As a result of today's inspection, deficiencies observed. Please see LIC 809-D.

Exit interview and a copy of the report and appeal rights will be provided to Licensee by close of business.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024
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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Document Has Been Signed on 09/19/2024 04:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 342700044

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(2)
§1569.625 Staff training; legislative findings; contents
(b) (2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file review, the licensee did not comply with the section cited above in two personnel records did not have the completed 20 hours of annual training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/04/2024
Plan of Correction
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Licensee is to establish a training schedule/plan to ensure all staff completes the required hours in a timely manner.
Copy of the plan is to be submitted to LPA Yang by POC due date 10/04/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024
LIC809 (FAS) - (06/04)
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