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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700856
Report Date: 06/30/2022
Date Signed: 06/30/2022 10:22:15 AM


Document Has Been Signed on 06/30/2022 10:22 AM - 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 IVFACILITY NUMBER:
342700856
ADMINISTRATOR:ARGANA, FERDINANDFACILITY TYPE:
740
ADDRESS:8734 SOTHEBY CT.TELEPHONE:
(916) 267-5275
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 4DATE:
06/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Jhona PettitTIME COMPLETED:
10:30 AM
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On 6/30/2022 at 9:35 AM, Licensing Program Analyst (LPA) Cassie Yang arrived to the facility to conduct a case management regarding late fees. LPA arrived to the driveway when met with Administrator, Maria Clardy, and a resident. It was then when LPA was informed the facility recently reported a resident testing positive for COVID-19 to LPA Angela Hood on 6/21/2022.

Prior to initiating today's visitation, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA was not screened by staff, and did not enter the community due to active COVID-19 case. LPA ensured the following Personal Protective Equipment (PPE) was worn: N-95 mask.

LPA asked if there was a co-Administrator available for her to talk to since Administrator, Maria, was taking a resident to an appointment. Maria confirmed co-Admin, Jhona Pettit, was present at the facility. LPA explained the purpose of the visit with Jhona. LPA stated the facility has an annual fee overdue of $742.00. Jhona explained that Maria is the owner who handles the payments for the facility and will informed Maria when she returns to the facility. LPA informed Jhona the payment was due 11/13/2021. LPA further explained Maria will need to take care of the payment right away along with the late fees.

As a result of this visit, no deficiency was found as LPA did not inspect the facility due to the active COVID-19 positive case. Exit interview conducted and copy of report was left with co-Administrator.

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022
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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