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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700995
Report Date: 06/01/2022
Date Signed: 06/01/2022 01:36:26 PM


Document Has Been Signed on 06/01/2022 01:36 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:PEARL CARE ASSISTED LIVINGFACILITY NUMBER:
342700995
ADMINISTRATOR:DANILIUC, DORINFACILITY TYPE:
740
ADDRESS:8523 WINDINGWAYTELEPHONE:
(916) 256-9400
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 5DATE:
06/01/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Aurelia Jurovschi, Lead caregiver and Dorin Daniliuc, Administrator TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection. LPA met with Aurelia Jurovschi, Lead caregiver, who contacted Administrator, Dorin Daniliuc, by phone, who arrived at approximately 11:50 am.

Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask.

A post-licensing inspection was not conducted on/around end of October 2021, 90 days following when the first resident moved in. The facility is licensed for (6) non-ambulatory residents and has an approved hospice waiver for (4). There are currently (2) residents on hospice.

A required annual and tour was also conducted today. LPA inspected the physical plant, kitchen, bedrooms(6), (3) bathrooms, laundry area, and backyard area. LPA observed the facility to be free of odor, clean and in good repair. There is sufficient furniture and lighting throughout the facility. LPA observed required 7 day non-perishable and 2 day perishable food. LPA observed locked medications, knives and toxins to be inaccessible to residents. LPA observed (1) resident file to be organized and complete.

LPA observed all required postings to be posted.

There are no deficiencies being cited.

Exit interview. Copy of report provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
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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