<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000691
Report Date: 08/28/2024
Date Signed: 08/28/2024 11:06:37 AM


Document Has Been Signed on 08/28/2024 11:06 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:COMPASSIONATE CARE HOMEFACILITY NUMBER:
347000691
ADMINISTRATOR:VANCEA, CORNELFACILITY TYPE:
740
ADDRESS:7030 SPICER DRIVETELEPHONE:
(916) 536-1343
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 0DATE:
08/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Cornel Vancea, LicenseeTIME COMPLETED:
11:20 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Michael Hood and Cassie Mikkelson arrived at the facility unannounced on 8/28/24 to conduct a Required-1 Year Inspection utilizing the inspection tool.

There are no residents residing at the facility at this time. LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPAs observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. LPAs checked the kitchen area for the ability to prepare and store food. LPAs observed the backyard and perimeter of the care home to be free of clutter and debris. LPAs checked medication storage and found medication to be inaccessible to residents.

LPAs requested copy of liability insurance. Administrator will inform the Department upon admission of the first resident.

As of today's visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted copy of report given at the conclusion of this visit.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1