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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700704
Report Date: 12/02/2021
Date Signed: 12/02/2021 03:21:20 PM

Document Has Been Signed on 12/02/2021 03:21 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:A HEARTY CARE HOME IFACILITY NUMBER:
342700704
ADMINISTRATOR:CLARDY, MARIA JFACILITY TYPE:
740
ADDRESS:5794 SPENLOW WAYTELEPHONE:
(916) 339-6440
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 6CENSUS: 4DATE:
12/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Elaine Lambert, CaregiverTIME COMPLETED:
03:45 PM
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On December 2, 2021, at 2:55pm, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a required annual inspection. LPA met with Elaine Lambert, Caregiver and explained purpose of inspection. Prior to initiating the 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; and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: mask. Elaine and LPA completed the inspection tool questionnaire with no issues or advisories to report.

LPA observed the following:
Administrator certificate is valid, expiring 3/21/2022. First aid kit fully stocked and ready for emergency use. Fire extinguishers fully charged. 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. Medication was properly stored and locked away.

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

Administrator shall submit the following documents to update the Regional Office files and submit them to Community Care Licensing by 1/2/2022:
-LIC 500 facility personnel or staff schedule
-LIC 610 emergency disaster plan
-LIC 308 designation of administrative responsibility
-copy of liability insurance
-updated facility sketch

Exit interview conducted and a copy of this report given to Elaine Lambert
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2021
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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