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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700111
Report Date: 12/21/2023
Date Signed: 12/21/2023 02:25:51 PM


Document Has Been Signed on 12/21/2023 02:25 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:DELICATE STEMS FOR THE ELDERLYFACILITY NUMBER:
342700111
ADMINISTRATOR:CLAUDIA MAHAIFACILITY TYPE:
740
ADDRESS:7008 HERSHBERGER COURTTELEPHONE:
(916) 370-2417
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:5CENSUS: 4DATE:
12/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Claudia Mihai, Administrator TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection related to a recent fire clearance update. LPA met with Alett Leby, caregiver, who contacted the Administrator, Claudia Mihai, to explain the reason for the inspection. Claudia arrived at approximately 1:50 pm.

LPA observed (1) outside health personnel to be visiting with a resident. LPA observed (1) resident sitting outside and (3) residents in their rooms.

LPA received an updated fire clearance on 12/19/23 from the local fire department permitting (5) non-ambulatory residents to reside in rooms #1, 2, 3. Specifically, room #1 is approved for (1) non-ambulatory residnte, room #2 is approved for up to (2) non-ambulatory residents and room #3 is approved for up to (2) non-ambulatory residents.

LPA and Administrator toured the facility and observed (4) residents to be present and residing in rooms #2 and #3. Currently room #1 is vacant but will be occupied soon.

Administrator advised that she wishes to convert some of the common area to a 4th resident bedroom and discussed with fire department recently. A smoke/monoxide alarms was recently installed and a permit will be taken out soon to complete some minor construction.

LPA issued an updated copy of the facility license to reflect the recent changes approved by the local fire department. LPA advised an annual inspection will be conducted between 1/20/23 and 3/20/23.

There are no deficiencies issued in this report.

Exit interview. Copy of report provided to the Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023
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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