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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002921
Report Date: 09/12/2024
Date Signed: 09/12/2024 05:05:36 PM


Document Has Been Signed on 09/12/2024 05:05 PM - 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:GRANNY'S COTTAGE LLCFACILITY NUMBER:
345002921
ADMINISTRATOR:BANCU, ADALBERTHFACILITY TYPE:
740
ADDRESS:7717 DEANTON CT.TELEPHONE:
(916) 606-9670
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 3DATE:
09/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Adalberth "Albert" Bancu, Administrator TIME COMPLETED:
05:05 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Albert Bancu, Administrator, and Floarea Bancu, caregiver, explaining purpose of inspection. Staff, Sabinel Bancu arrived at 2:35 pm. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (6). Currently, there are (0) residents on hospice.

LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) shared resident bedrooms, (2) private resident bedrooms, (2) resident bathrooms, (1) staff/visitor bathroom, kitchen, staff room and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free. Vacant resident rooms have required furniture. Bathrooms have grab bars, non-skid flooring, shower chair and hygiene supplies. 20 second hand-washing instructions to be posted above all sinks. There are sufficient linens/towels/blankets/PPE and sufficient 2+day perishable and 7+day non-perishable food on hand. Sharps are locked in the kitchen, medications are secured nearby and toxins are locked in the laundry/garage area. Inside temperature measured 80*F. Fire extinguisher was last serviced 6/21/24 and smoke/monoxide alarms in working order. There is a complete first aid kit. Hot water temperature measured 118*F in the kitchen. All door alarms work throughout and screens are in good condition. There are (2) internet devices for resident use. There is (1) unlocked gate and a fountain/pond enclosed by a 3-foot fence.
LPA reviewed (2) of (3) staff files and found them to be organized, current and contain the required documentation. Medications were checked for (2) residents- orders match medications being given and documentation is current. All staff (3) have current First Aid/CPR and have completed the required yearly training. Administrator certificate #6019037740-exp 9/6/24 is pending renewal. Other topics discussed.

An updated copy of liability insurance was obtained. LIC308 and LIC500 to be provided by 9/19/24.
There were no deficiencies observed. Exit interview. Copy of report provided to the Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2024
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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