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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700264
Report Date: 12/31/2021
Date Signed: 12/31/2021 03:43:39 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:I LOVE YOU DADFACILITY NUMBER:
342700264
ADMINISTRATOR:ARDELEAN, EMILIAFACILITY TYPE:
740
ADDRESS:6613 TRILBY COURTTELEPHONE:
(916) 529-3930
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 5DATE:
12/31/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Emilia Ardelean, Administrator TIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPA's) Sabrina Calzada and Cassie Yang arrived unannounced to conduct a required annual. LPA's met with Nicola Dixon, and StacyAnn Bennett , caregivers. LPA's met with Emilia Ardelean, Administrator, who arrived at 2:45 pm. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. Additionally, LPA's were screened per Covid-19 precautionary measures upon entering the community. LPA's ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 or surgical mask. Facility currently has (5) residents and (2) residents are on hospice. LPA's observed (2) residents to be watching television in the front room and (3) residents to be resting in their rooms.

LPA's and caregiver toured the interior of the facility, including (5) private resident rooms, bathrooms, kitchen, laundry room, staff room and common areas. LPA's observed it to be clean, in good repair and odor free. LPA's observed various Covid posters throughout. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA's and Licensee completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 76* F. LPA's observed sufficient 2+day perishable and 7+day non-perishable food. LPA's observed paper towels, soap, sanitizer and Covid posters. Administrator to purchase trash cans with a lid. LPA's observed ample PPE supply. Sharps, Toxins and medications were secured in kitchen area. LPA's observed required postings in the facility. LPA's and Administrator discussed vaccination status of residents and staff as well as visitation protocols per PIN 21-40 issued, 8/27/2021. LPA's observed expired Administrator certificate #6026914740-
(exp 5/17/2021) posted; however, Licensee's son, Emil Ardelean, has a provisional Administrator certificate and new hiree, Stacy Barnes, has a current Administrator certificate. Licensee to provide the Department with a copy of each current Administrator certificate as well as additional paperwork to change Administrator to Stacy Barnes.

LPA requested an updated copy of LIC308 and obtained a current copy of liability insurance and LIC500 by 1/7/2022. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator.







SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021
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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