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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700429
Report Date: 09/01/2021
Date Signed: 09/01/2021 04:03:57 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:NEW LIFEFACILITY NUMBER:
342700429
ADMINISTRATOR:CUSTURA, VLADFACILITY TYPE:
740
ADDRESS:6307 GRANT AVETELEPHONE:
(916) 285-5302
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
09/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator, Vlad CusturaTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Llopis arrived at the facility unannounced on 09/01//2021 to conduct a Required - 1 Year Inspection utilizing the infection control domain. Prior to initiating the annual inspection LPA completed required COVID-19 testing protocols and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon entering LPA conducted a facility risk assessment.

LPA applied hand sanitizer prior to entering the facility and wore the following personal protective equipment (PPE) during today's visit: N95 mask. LPA met with administrator Vlad Custura and explained the purpose of the visit.

LPA and administrator toured the facility together, areas toured include but are not limited to: common areas, kitchen, resident bedrooms, bathrooms, and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA and administrator completed the infection control domain together and facility was found to be in compliance at this time.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
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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