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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701557
Report Date: 01/22/2025
Date Signed: 01/22/2025 11:51:08 AM

Document Has Been Signed on 01/22/2025 11:51 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HARMONY CARE HOMEFACILITY NUMBER:
342701557
ADMINISTRATOR/
DIRECTOR:		EVBUOMWAN, OSAZEMEFACILITY TYPE:
735
ADDRESS:4348 ARCTIC TERN CIRTELEPHONE:
(916) 842-0124
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY: 4CENSUS: 0DATE:
01/22/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Osazeme EvbuomwanTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived announced to conduct a prelicensing inspection. LPA Moleski met with applicant Osazeme Evbuomwan and explained the purpose of the visit.

LPA Moleski reviewed Evbuomwan's application documents and sample client files. LPA Moleski conducted Component III orientation with Evbuomwan.

LPA Moleski toured the property with Evbuomwan and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility's water temperature measured 112 degrees Fahrenheit, which is within the required range of 105 and 120 degrees.

LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked closet for the storage of medication. LPA Moleski observed a locked closet for the storage of cleaning solutions and knives.

LPA Moleski has no objections to licensure. The applicant has passed their prelicensing inspection. An exit interview was conducted and a copy of this report was left with Evbuomwan.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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