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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002881
Report Date: 08/05/2022
Date Signed: 08/05/2022 11:36:20 AM


Document Has Been Signed on 08/05/2022 11:36 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:CARE HORIZONS ASSISTED LIVING, LLCFACILITY NUMBER:
345002881
ADMINISTRATOR:IORDACHE-STIR, ADRIANAFACILITY TYPE:
740
ADDRESS:6630 CARE LANETELEPHONE:
(916) 205-2273
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
08/05/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Adriana Iordache-StirTIME COMPLETED:
11:15 AM
NARRATIVE
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An office meeting was held on August 8,2022 at 10:30 AM on a Microsoft Teams Meeting video conferencing system review the stipulation adopted on July 27, 2022 and the next steps. This Stipulation shall be posted in a conspicuous place at the facility for the duration of the probationary period.

The following were in attendance: Regional Manager Alycia Berryman, Licensing Program Manager Maribeth Senty, Licensing Program Analyst Kevin Mknelly and Licensees for Care Horizon Assisted Living, LLC and Care Horizon Assisted Living II, Adriana Iordache-Stir and Dragos “Adrian” Iordache-Stir.

Alycia Berryman discussed the purpose and elements of this type of meeting.

The Stipulation was reviewed with, Administrators, and Licensees who expressed their understanding.

Items discussed at the meeting included, but not limited to:
Stipulation contents
· Findings
· Revocation of License- Stayed with Probation
· Denied applications for licensure
· Probationary license period of three (3) years for Care Horizons Assisted Living II and Eighteen (18) months for Care Horizon Assisted Living, LLC.
· Licenses limitations and conditions
· Future Application for a license, registration, certification or approval
· Tolling of probationary period

Report continued...
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: CARE HORIZONS ASSISTED LIVING, LLC
FACILITY NUMBER: 345002881
VISIT DATE: 08/05/2022
NARRATIVE
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· Violation of Stipulation Term
· Completion of probation
· Revocation of Administrator certificates stayed for probationary periods
· Terms and Conditions for Adrian
· Terms and Conditions for Adriana
· Violation of Stipulation Term
· Department’s Authority
· Monitoring Fee
· Waiver of Hearing Rights
· Waiver of Appeal/Modification Rights
· Waiver of Claims
· Severable terms
· Public Record
· Signatures
· Counterparts
· Effective Date July 27, 2022
· No Oral modification
· Process for request for early termination if requested

The Licensees/Respondents/Representatives stated they would abide by the following:
ꞏ Abide by the contents/terms of the Stipulation (submit all documents timely)
ꞏ Operate the facility in strict compliance with the regulations and statutes governing the operation of a
residential care facility for the elderly.

CCLD will do the following:
ꞏ Increase monitoring

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations cited during this visit. A virtual exit interview was conducted, and a copy of this report was provided via email for a signature. Administrator agreed to return a signed copy to CCLD by COB 8/5/22.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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