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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002942
Report Date: 08/31/2023
Date Signed: 08/31/2023 01:00:56 PM


Document Has Been Signed on 08/31/2023 01:00 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:SABINA'S CARE HOMEFACILITY NUMBER:
345002942
ADMINISTRATOR:MIHAI, CLAUDIAFACILITY TYPE:
740
ADDRESS:8261 SUNBONNET CT.TELEPHONE:
(916) 730-7563
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 6DATE:
08/31/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Emilia "Amy" Ardelean, House ManagerTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the care home today and met with House Manager, Emilia "Amy" Ardelean, to follow-up regarding technical assistance provided during an inspection conducted on 8/24/2023 regarding current Administrator.

LPA met with new Administrator, Iryna Omelian, and reviewed documentation for Administrator placement. LPA will update information regarding current Administrator.

No deficiencies were cited at today's visit. Exit interview conducted and copy of report provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
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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