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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002990
Report Date: 02/15/2024
Date Signed: 02/15/2024 04:02:02 PM


Document Has Been Signed on 02/15/2024 04:02 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:CITRUS HEIGHTS SENIOR LIVINGFACILITY NUMBER:
345002990
ADMINISTRATOR:DOCMANOV, MIODRAGFACILITY TYPE:
740
ADDRESS:8440 EDGECLIFF CTTELEPHONE:
(916) 678-2908
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 4DATE:
02/15/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Magda Szanto, lead caregiver and Elena Docmanov, lead caregiver TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Naomi White, caregiver, and stated reason for the inspection. (3) residents were finishing lunch in the common area. (1) resident was in his room. The facility is licensed for (5) non-ambulatory residents, (1) bedridden resident. Currently there are (0) residents on hospice.

LPA spoke to the Administrator, Anamaria Documanov, by phone, who stated the lead caregivers would attend. Magda Szanto and Elena Docmanov, lead caregivers and Administrator Designee, who arrived at approximately 1:00 pm.

This report is being generated to clear the post-licensing in the system.

There are no deficiencies noted on this report.

Exit interview. Copy of report provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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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