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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000786
Report Date: 04/21/2022
Date Signed: 04/21/2022 02:44:41 PM


Document Has Been Signed on 04/21/2022 02:44 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:DANUBIUS HOME CAREFACILITY NUMBER:
347000786
ADMINISTRATOR:LIUBA CIOTICFACILITY TYPE:
740
ADDRESS:8261 SUNBONNET DRIVETELEPHONE:
(916) 961-5933
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 5DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Liuba Ciotic, Administrator TIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with caregiver, Rosetta Russell- Price, and explained purpose of inspection. Administrators, Liuba Ciotic arrived at 12:45 pm and Daniela Mangu arrived at 1:00 pm. Emilia Ardelean, Assistant Manager, arrived at approximately 1:20 pm. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask. LPA observed (3) residents in the common area watching television and (2) residents to be in their rooms. There is currently (0) resident on hospice services.

Administrators, Liuba Ciotic and Daniela Mangu advised LPA there is a pending change of ownership and they will soon issue a 60- day notice to the residents and responsible persons. LPA advised to also provide a copy of the letter to the Department.

LPA and Administrator, Liuba, toured the interior and exterior of the facility, including (4) private resident bedrooms, (1) shared resident bedroom, (2) bathrooms, kitchen, common areas, laundry area, staff room and garage/storage area. LPA observed all areas toured to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. Inside temperature was observed to be 71* F. Fire extinguisher last serviced 1/11/2022. LPA observed locked toxins, medications and sharps and sufficient 2+day perishable/7+day non-perishable food. First aid kits on site. Smoke/ monoxide in working order. Exit doors have alarms on them. LPA observed paper towels, soap, sanitizer, and hand-washing posters in the bathrooms. LPA observed sufficient PPE supply and incontinent products on hand and activities, and books. There is (1) outside gate that is unlocked from the inside and there is a pool on site that is gated and locked. LPA observed various Covid posters throughout as well as other required postings and a binder with Provider Information Notices (PIN) issued from the Department.
cont on 809C..

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: DANUBIUS HOME CARE
FACILITY NUMBER: 347000786
VISIT DATE: 04/21/2022
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LPA observed PIN 22-07, issued, 2/7/2022, to be posted. Discussed vaccination status of residents and staff and observed facility to be maintaining verification of vaccination status on file of visitors. Discussed scheduling booster shots with families for residents that don't' have them yet.

LPA requested an updated copy of LIC500 and was provided with a copy of the current liability insurance today.

Exit interview. There were no deficiencies observed during today's inspection.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
LIC809 (FAS) - (06/04)
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