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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700208
Report Date: 10/27/2021
Date Signed: 10/27/2021 01:52:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:AMORUSO CARE HOMEFACILITY NUMBER:
342700208
ADMINISTRATOR:CHIRA, TITIANAFACILITY TYPE:
740
ADDRESS:8967 AMORUSO AVENUETELEPHONE:
(916) 475-7261
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 5DATE:
10/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Titiana Chira, Administrator TIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Titiana Chira, Administrator, and explained purpose of inspection. V Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA confirmed there are no residents or staff with a confirmed case or signs/symptoms or Covid. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. LPA observed all (5) residents to be in their rooms and no residents are on hospice. LPA met with Virorica Siciu, manager, who arrived at the facility and showed a copy of LIC808 to LPA.

LPA and Administrator toured the interior of the facility. LPA observed it to be clean, in good repair and to have no foul odors. LPA observed various Covid posters throughout. Rooms toured include (3) private bedrooms, (1) shared bedrooms, (2) bathrooms, kitchen, laundry, garage and common areas. In the areas toured no immediate health, safety, or personal rights violations were observed. Inside temperature was observed to be 75* F. LPA observed sufficient 2+day perishable and 7+day non-perishable food. LPA observed paper towels, soap and sanitizer, trash can with lid and hand-washing poster in the bathrooms. LPA observed sufficient PPE supply. Discussed vaccination status of residents and staff. LPA observed fire extinguisher to be serviced last on 3/22/2021. LPA observed required postings at the facility. LPA, Administrator and manager completed the infection control domain and facility was found to be in compliance at this time.

Manager to fax copy of liability insurance and copy of LIC808. Administrator certificates (2) are pending renewal per manager.

There were no deficiencies observed during today's inspection.

Exit interview. Copy of report provided to facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
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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