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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002884
Report Date: 08/22/2022
Date Signed: 08/22/2022 10:30:09 AM


Document Has Been Signed on 08/22/2022 10:30 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 IIFACILITY NUMBER:
345002884
ADMINISTRATOR:IORDACHE, DRAGOS ADRIANFACILITY TYPE:
740
ADDRESS:6640 CARE LANETELEPHONE:
(916) 229-7154
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 5DATE:
08/22/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Dragos Adrian Iordache TIME COMPLETED:
10:45 AM
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On 8/22/2022, Licensing Program Analyst (LPA) Cassie Yang arrived announced at the facility to conduct a Pre-licensing inspection for change of ownership referencing the infection control domain. LPA met with Administrator/Licensee, Dragos Adrian Iordache, and explained the purpose of the visit. Prior to initiating the inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility.

LPA toured the interior and exterior of the facility together with Licensee to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathrooms, kitchen, laundry room, garage and backyard. In the areas toured, no immediate health, safety, or personal rights violations were observed. LPA observed sharps, toxics and medications to be secured. Fire extinguisher was last serviced 6/13/2022.

LPA and Licensee completed the infection control recommendations and facility was found to be in substantial compliance at this time. LPA confirmed that masks were worn by staff.

Component III waived as the current facility Administrator, Dragos Adrian Iordache, will remain the same.

No deficiencies are being cited as a result of today's inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2022
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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