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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700327
Report Date: 07/15/2024
Date Signed: 07/15/2024 02:06:25 PM


Document Has Been Signed on 07/15/2024 02:06 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:A & V COMFORT HOME CAREFACILITY NUMBER:
342700327
ADMINISTRATOR:VERES, VASILEFACILITY TYPE:
740
ADDRESS:5604 NORTH AVETELEPHONE:
(916) 487-7015
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
07/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Vasile Veres, Administrator and Maria Vasile, LIcenseeTIME COMPLETED:
02:05 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Maria Veres, Licensee, and Vasile Veres, Administrator, and explained purpose of inspection. LPA observed (3) residents to be later eating lunch in the common area and (3) residents in their rooms. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (4) residents. Currently, there are (3) residents on hospice. LPA observed a hospice nurse present at the start of the inspection.

LPA and Administrator toured the interior and exterior of the facility including the common areas, resident bedrooms, resident bathrooms (2), kitchen, and laundry. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting throughout. Both bathrooms have the necessary grab bars, non-skid flooring, paper towels, and hand-washing poster. There is sufficient 2+day perishable and 7+day non-perishable supply of food and locked sharps and medications are stored in the kitchen. There are locked toxins in the laundry room. The inside temperature measured at 76*F, and the hot water measured 106*F in the kitchen. The water heater shows the hot water set at 120*F for the resident side of the facility.. Fire extinguisher was last serviced 6/17/24, and the smoke/monoxide alarms are in working order. Outside, there is a covered patio area with seating, storage sheds with paper and other supplies and (2) unlocked exit gates. All required postings up. Infection Control Plan and Emergency Disaster Plan reviewed. There was a new A/C unit installed last week.

LPA reviewed (3) resident files and found them to be organized, complete and contain current documentation. Medications were reviewed for (2) residents- orders matched medications being given. LPA reviewed (2) of (2) staff files and found them to be organized, complete and contain current First Aid/CPR certifications. All staff are cleared/associated. Administrator certificate #6019191740- exp 11/16/24. LPA obtained an updated copy of insurance and requested updated copy of LIC500- due by 7/22/24.

There are no deficiencies issued; however, a Technical Advisory Note is issued since staff training was last completed July 2023 (due by July 2024).
Exit interview. Copy of report provided to the Administrator and Licensee.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024
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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