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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002881
Report Date: 08/31/2023
Date Signed: 08/31/2023 11:40:52 AM


Document Has Been Signed on 08/31/2023 11:40 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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:
08/31/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Adriana Iordache-Stir, AdministratorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced on 8/31/2023 to conduct a Case Management Legal visit in accordance with the Stipulation and Order effective 7/27/2022. A copy of the Stipulation and Order is posted in a conspicuous place and is available for review upon request. LPA met with the Administrator, Adriana Iodarche-Stir

During today's visit, LPA reviewed the following stipulations of the order:

1. Staff shall have criminal record clearance
-LPA checked criminal record clearance for all staff

2. Facility shall be clean, safe, and sanitary
-LPA toured facility which was clean, safe, and sanitary

3. Facility shall ensure that poisons, detergents, cleaning compounds, and other toxic products are locked away
-LPA toured facility and all products that could pose a danger to residents in care were locked away

4. Facility has not accepted residents with restricted health conditions

LPA observed facility to be in compliance and residents receiving care. No deficiencies are being cited. Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 214-0485
LICENSING EVALUATOR NAME: Angela HoodTELEPHONE: 650-676-0390
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
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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