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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000931
Report Date: 11/08/2023
Date Signed: 11/08/2023 11:40:46 AM


Document Has Been Signed on 11/08/2023 11:40 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:CANDLELIGHT HOME CAREFACILITY NUMBER:
347000931
ADMINISTRATOR:DOBRE, EMILFACILITY TYPE:
740
ADDRESS:7224 CANDLELIGHT WAYTELEPHONE:
(916) 725-5680
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 6DATE:
11/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Emil DobreTIME COMPLETED:
12:00 PM
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On 11/08/2023, Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Bethany Mirlohi arrived unannounced at the facility to conduct a Required 1- year annual inspection utilizing the care tool. LPAs met with Administrator Emil Dobre.

LPAs and Administrator conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: four private and one shared residents room, three bathrooms, kitchen, laundry room, backyard, storage area, and the common areas. LPAs observed four residents in the common area watching television and two residents in their rooms. LPAs observed the facility to have 2+ days of perishable and 7+ days of nonperishable foods. LPAs observed that sharps and medications are locked.

LPAs conducted a file review of two personnel and three residents records. LPAs also conducted a medication to check.

LPAs completed the full care tool and no deficiencies was observed.

Exit interview conducted and a copy of the report was left with Administrator.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Cheyenne RatajczakTELEPHONE: (916) 969-7879
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
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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