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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700111
Report Date: 03/01/2024
Date Signed: 03/01/2024 02:28:06 PM


Document Has Been Signed on 03/01/2024 02:28 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:
03/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
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 required annual inspection. LPA met with caregivers, Jellee Grant and Kendy Grant, who contacted the Administrator, Claudia Mihai, to state the reason for the inspection. Administrator arrived at 11:45 am. LPA observed (2) residents eating at the dining room table and (2) residents in their room. Staff, Laura Doxan and Licensee, Elena Giuchici, arrived at 12:30 pm. There are currently no residents under hospice care.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (3) resident bedrooms, (2) full bathrooms, kitchen, office, staff room, and locked laundry area/garage. LPA observed the facility to be clean, in good repair and odor free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels, soap and trash can. There is sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and toxins in the kitchen. Medications are secured nearby and additional locked toxins in the laundry area.Fire extinguisher was last serviced 3/22/2023 and the smoke monoxide alarms are working. There are multiple Covid posters and other required postings in the common area. Facility conducts quarterly fire drills. There are sufficient linens/towels/paper products/PPE. Inside temperature measured 75*F and hot water measured 105*F in the kitchen. First aid kit is complete. There is one unlocked exit gate outside.

LPA reviewed (3) resident binders and found the documentation to be current and complete. Medications were reviewed for (2) residents and there were no discrepancies noted. LPA reviewed (4) staff files. All staff is cleared/associated and has current training, including First Aid/CPR. LPA reviewed/approved the Infection Control Plan. Emergency Disaster Plan is complete. LPA obtained an updated copy of current liability insurance, and requested LIC500 and LIC308 be submitted to the Department by 3/8/24.

Exit interview with lead staff, Laura. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024
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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