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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002881
Report Date: 07/16/2024
Date Signed: 07/16/2024 11:59:16 AM


Document Has Been Signed on 07/16/2024 11:59 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:
07/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sheree Hall ThompsonTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday July 16, 2024 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed resident (6) and staff files (2). All resident files contained the required paperwork. Staff files contained the required paperwork and training.

LPA Parks and staff Sheree toured the facility together to ensure the health and safety of residents in care. The areas toured included staff room, resident rooms, bathrooms, living room, kitchen, garage, and backyard. In the areas toured, there were no health or safety violations observed.

Facility was clean and well organized. All required posting were observed. All knives/sharps are kept locked and inaccessible to residents. Chemicals were kept locked in the laundry room. First aid kit was fully stocked. Fire extinguisher had a current inspection tag.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2024
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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