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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700595
Report Date: 08/31/2022
Date Signed: 08/31/2022 02:00:37 PM


Document Has Been Signed on 08/31/2022 02:00 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ALECSANDRU'S LOVING CAREFACILITY NUMBER:
342700595
ADMINISTRATOR:LITA, REBECAFACILITY TYPE:
740
ADDRESS:6129 SUNDAY DRIVETELEPHONE:
(916) 550-0963
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:6CENSUS: 5DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Rebeca Lita, AdministratorTIME COMPLETED:
02:29 PM
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On August 31, 2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived conduct the 1 year required annual inspection. LPA met with Administrator Rebeca Lita and informed her the reason for the visit.

Prior to initiating the visit, 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 and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and a N-95 mask was worn for Personal Protective Equipment. Also, staff screened upon arrival.

Rebeca and LPA completed the inspection tool questionnaire with no issues or advisories to report.

LPA observed the following:
Administrator certificate is valid, expiring 6/2/2024. First aid kit fully stocked and ready for emergency use. Fire extinguisher is fully charged . The home was73 degrees F. Which is in the right temperature range.

Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Facility has required (2) day perishable supply of food and (7) supply of non-perishable food.
Exterior of the home is in good repair with no bodies of water on the premises. Medications were locked up and MARS log was current and complete.

As a result of this visit, no deficiencies were cited, per Title 22 Regulations, Division 6.

The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file in our Regional Office. Administrator shall submit the listed documents to Licensing later than September 30, 2022.

Exit interview conducted and a copy of this report given to Rebecca

SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-LyonsTELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022
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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