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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 01:30:57 PM


Document Has Been Signed on 06/01/2022 01:30 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:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Aurelia Jurovschi, Lead caregiver and Dorin Daniliuc, Administrator TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Aurelia Jurovschi, Lead caregiver, who contacted Administrator,Dorin Daniliuc, by phone. Administrator arrived at facility 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.

LPA observed (2)) residents in the common area watching television, and (2) residents to be resting in their rooms and (1) resident was at an appointment. There are currently (2) residents on hospice services. LPA observed (1) resident return from an appointment during today's inspection.

LPA and Lead caregiver toured the interior and exterior of the first floor of the facility, including (6) private resident bedrooms, (3) bathrooms, kitchen, common areas, locked laundry room, and office/storage area. LPA observed all areas toured to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. Administrator resides on the second floor and there is a locked gate at the bottom of the stairs. Inside temperature was observed to be 78* F. All exit doors have alarms on them. LPA observed paper towels, soap, sanitizer, and hand-washing posters in the bathrooms. LPA observed sufficient PPE supply and incontinent products. There is (1) outside gate that is unlocked from the inside. LPA observed various Covid posters throughout as well as other required postings. Discussed vaccination status of residents and staff with Administrator and requirement to maintain records of visitor vaccination status or test results and staff vaccination status or exemption. Discussed scheduling a second booster shot with families of residents.

LPA requested an updated copy of LIC308, LIC500 be provided to the Department by 6/8/22. LPA obtained a copy of the current liability insurance during today's inspection.

There were no deficiencies observed during today's inspection.

Exit interview with Administrator. Copy of report left at facility.
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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